Development and preliminary results on the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics

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Abstract

Background

Adherence to the diet prescription for chronic kidney disease is suboptimal. Interventions to improve dietary adherence suggest that improving communication between the patient and the health professional is fundamental to improving outcomes. Providing patients with a question prompt sheet prior to the consultation has been demonstrated to be an effective method for improving communication between patient and health professional. In the absence of a renal diet specific version, the aims of this study were to develop and test the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics.

Methods

Phase one utilized social listening methodology, online content analysis and clinic observations to obtain an extensive list of frequently asked questions about the renal diet. Following refinement with health professionals, the draft question prompt sheet was then sent in Phase two to patients one week prior to their scheduled consultation with the renal dietitian. Feedback was obtained from patients, carers and dietitians using semi structured interviews post clinic consultation. Quantitative data was analyzed using counts and proportions, while free text responses were analyzed thematically.

Results

A total of 769 unique renal diet related questions were reduced to an 18-item question prompt sheet. Feedback from thirteen patients (six males), six carers and six dietitians involved in the preliminary feasibility study was overwhelmingly positive. The majority of patients found the question prompt sheet to be easy to understand and agreed it facilitated communication with the dietitian. All participants agreed that they would recommend use of question prompt sheet to other patients. Suggestions for future use included health professional training in use of the sheet, particularly about how to help patients prioritize their most important questions.

Conclusions

The 18-item renal diet question prompt sheet developed in this preliminary study appears to be a feasible tool for use in nephrology consultations especially by dietitians. Further research quantifying the impact on question asking and patient centeredness should be undertaken. In addition, user testing with patients from culturally diverse and low literacy backgrounds would be useful.

Electronic supplementary material

The online version of this article (10.1186/s12882-019-1231-3) contains supplementary material, which is available to authorized users.

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Most cited references 13

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Angelo Volandes, Michael Paasche-Orlow (2007)

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy.

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Effects of dietary phosphate restriction and phosphate binders on FGF23 levels in CKD.

Angel Vargas-Ruíz, Wilson K. Smith, Myles Wolf … (2013)

Elevated levels of fibroblast growth factor 23 (FGF23) are associated with increased risk of adverse outcomes in patients with CKD. Reducing dietary phosphate intake or absorption may decrease FGF23 levels, but data on the combined effects of dietary phosphate restriction and phosphate binders in CKD are limited. In this 2×2 factorial, single-blinded, placebo-controlled, 3-month study, conducted between July 2009 and March 2012, 39 patients with CKD stages 3 or 4 and normal serum phosphate levels were randomly assigned to one of four groups: ad libitum diet plus lanthanum carbonate (LC) placebo (n=10), 900-mg phosphate diet plus LC placebo (n=10), ad libitum diet plus LC (n=11), or 900-mg phosphate diet plus LC (n=8). The dose of LC was 1000 mg three times daily with meals. Dietary restriction was accomplished with outpatient counseling. The primary end point was change in FGF23 levels from baseline. Compared with ad libitum diet, the 900-mg phosphate diet did not significantly reduce FGF23 levels (diet × time interaction, P=0.05). Compared with placebo, LC alone also did not significantly reduce FGF23 levels (LC × time interaction, P=0.21). However, the dual intervention significantly decreased FGF23 levels throughout the study period (diet × LC × time interaction, P=0.02), resulting in a 35% (95% confidence interval, 8%-62%) reduction by study end. The combination of LC plus counseling for a phosphate-restricted diet decreased FGF23 levels in patients with CKD stages 3-4 and normal serum phosphate levels.

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Interventions to improve recall of medical information in cancer patients: a systematic review of the literature.

Nienke van der Stoep, Jozien Bensing, Sandra van Marwick … (2008)

This systematic review investigates which interventions are effective to improve recall of medical information in cancer patients. A literature research was done in PubMed, PsychINFO, CINAHL and Cochrane Library, following the guidelines of the Cochrane Collaboration. The methodological quality of selected studies was assessed independently by two reviewers. The results were synthesized with a Best Evidence Synthesis. Of initially 5173 found publications, 10 met all selection criteria. The results indicate that an audiotape of the patients' own consultation has added value upon oral information only. However, providing patients with a general audiotape does not improve recall of information and might even inhibit patients' recall. Furthermore, there is scientific evidence, although limited, that the use of a question prompt sheet (QPS) has a positive effect on recall of information, provided that the physician actively endorses this sheet. No evidence was found for an effect of providing patients with a summary letter of the consultation on recall, although research on this subject is scarce. In conclusion, the review suggests that interventions that are tailored to the individual cancer patient, such as an audiotape of the consultation or a QPS, are most effective. Further research needs to be done to establish robust results. (c) 2007 John Wiley & Sons, Ltd.

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Author and article information

Contributors

Kelly Lambert:

ORCID: http://orcid.org/0000-0001-5935-7328

kelly.lambert@health.nsw.gov.au

Tsz Kwan Lau: tkkl390@uowmail.edu.au

Sarah Davison: sarah.davison@health.nsw.gov.au

Holly Mitchell: holly.mitchell@health.nsw.gov.au

Alex Harman: alexandra.harman@health.nsw.gov.au

Mandy Carrie: mandy.carrie@health.nsw.gov.au

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 12 February 2019

Publication date PMC-release: 12 February 2019

Publication date Collection: 2019

Volume: 20

Electronic Location Identifier: 48

Affiliations

[1 ]ISNI 0000 0000 9781 7439, GRID grid.417154.2, Department of Clinical Nutrition, , Wollongong Hospital, ; Illawarra Shoalhaven Local Health District, Level 5 Block C, Crown Street, Wollongong, NSW 2500 Australia

[2 ]ISNI 0000 0004 0486 528X, GRID grid.1007.6, School of Medicine, Faculty of Science, Medicine and Health, , University of Wollongong, ; Northfields Ave, Wollongong, NSW 2522 Australia

Author information

Kelly Lambert http://orcid.org/0000-0001-5935-7328

Article

Publisher ID: 1231

DOI: 10.1186/s12882-019-1231-3

PMC ID: 6373020

PubMed ID: 30755163

SO-VID: 33c6d025-ba71-4790-ab86-db760b80b579

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 11 December 2018

Date accepted : 25 January 2019

Funding

Funded by: National Health and Medical Research Council Australia

Award ID: APPID 1150099

Award Recipient : Kelly Lambert

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: patient-centered care,self-management,chronic kidney disease,health communication,feasibility study,dietitian,nephrology

Data availability:

ScienceOpen disciplines: Nephrology

Keywords: patient-centered care, self-management, chronic kidney disease, health communication, feasibility study, dietitian, nephrology

Development and preliminary results on the feasibility of a renal diet specific question prompt sheet for use in nephrology clinics

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Most cited references 13

Health literacy, health inequality and a just healthcare system.

Effects of dietary phosphate restriction and phosphate binders on FGF23 levels in CKD.

Interventions to improve recall of medical information in cancer patients: a systematic review of the literature.

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