Patient education or patient motivation – is information enough?

L Hanna, J Brown

Belfast City Hospital

PROBLEM: All patients receive individual education about kidney transplantation,

the importance of not smoking, following dietary restrictions, maintaining an ideal weight and adhering to medication. Due to the ongoing shortage of organs and the longer waiting time for kidney transplantation, we felt it was important to encourage and to motivate those on call to follow medical advice. This would help to reduce co-morbidities and to improve long-term outcomes.

PURPOSE: To improve the patient’s knowledge about their general health, to assess adherence to the information provided by the Patient Education Team and to improve the quality of this service.

DESIGN: Questionnaires, designed by nursing staff included Likert scales and were posted to all 210 patients awaiting kidney transplantation to assess their understanding and motivation. We also compared levels of potassium, phosphate and inter-dialytic weight gain in this sample group.

FINDINGS: All patients had received information from the Patient Education Team about kidney transplantation and general health management. However, only 47% of patients responded to the survey, and while 96% appeared to recognise the importance of health issues and 79% indicated they do try to follow advice – we have to be mindful of those who did not complete questionnaires. 57% of respondents were interested in attending workshops on diet and fluid management, exercise on dialysis, transplantation and emotional support.

CONCLUSION: All patients prior to going on call for kidney transplantation should receive information on procedures involved and information on the importance of following general health advice. However, it is evident that not all patients adhere. In an effort to motivate this group, the Patient Education Team have been running workshops to teach staff the techniques of Motivational Interviewing. We aim to modify patient behaviour by helping staff explore with the patient what may help or hinder the patient from making appropriate changes.

RELEVANCE: A significant number of long-term dialysis patients appear to lack the motivation required to adhere to a restrictive lifestyle. Staff must recognise the difficulties this group faces and staff need to be equipped to support and to encourage patients during their dialysis treatment. A Motivational Interviewing approach may be one way of addressing the patient’s current behaviour and how it is likely to impact upon their future health.