Characterizing Illness Perception Phenotypes in Older Adults With Chronic Kidney Disease

Abstract An individual’s understanding of their chronic illness (illness perception) is a psychological resource that has an impact on coping and self-management behaviors. Our previous study identified illness perception phenotypes (overall patterns of illness perceptions) in a sample of older adults with heart failure, COPD, and chronic kidney disease. These phenotypes were associated with perceived self-management ability (patient activation) and recent hospitalizations. To further characterize the illness perception phenotypes we focused on older adults with chronic kidney disease, analyzing illness perception data along with potential covariates from the multi-center longitudinal Chronic Renal Insufficiency Cohort study (CRIC). Covariates include sociodemographics, disease parameters, personality type, disease knowledge, and treatment adherence. While personality type was associated with illness perception phenotype, disease knowledge and treatment adherence were not. We have also conducted qualitative analyses of in-depth interviews. These results will inform the development of a pilot intervention incorporating illness perception information into the clinical setting.

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Patients’ and healthcare professionals’ beliefs, perceptions and needs towards chronic kidney disease self-management in China: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-044059 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044059

Author(s):

Hongxia Shen ◽

Rianne M J J van der Kleij ◽

Paul J M van der Boog ◽

Wenjiao Wang ◽

Xiaoyue Song ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Qualitative Study ◽

Healthcare Professionals ◽

Illness Perceptions ◽

Chinese Patients ◽

Self Management ◽

Tertiary Referral Hospital ◽

Chinese Context ◽

Management Interventions

ObjectivesTo support the adaptation and translation of an evidence-based chronic kidney disease (CKD) self-management intervention to the Chinese context, we examined the beliefs, perceptions and needs of Chinese patients with CKD and healthcare professionals (HCPs) towards CKD self-management.DesignA basic interpretive, cross-sectional qualitative study comprising semistructured interviews and observations.SettingOne major tertiary referral hospital in Henan province, China.Participants11 adults with a diagnosis of CKD with CKD stages G1–G5 and 10 HCPs who worked in the Department of Nephrology.ResultsFour themes emerged: (1) CKD illness perceptions, (2) understanding of and motivation towards CKD self-management, (3) current CKD practice and (4) barriers, (anticipated) facilitators and needs towards CKD self-management. Most patients and HCPs solely mentioned medical management of CKD, and self-management was largely unknown or misinterpreted as adherence to medical treatment. Also, the majority of patients only mentioned performing disease-specific acts of control and not, for instance, behaviour for coping with emotional problems. A paternalistic patient–HCP relationship was often present. Finally, the barriers, facilitators and needs towards CKD self-management were frequently related to knowledge and environmental context and resources.ConclusionsThe limited understanding of CKD self-management, as observed, underlines the need for educational efforts on the use and benefits of self-management before intervention implementation. Also, specific characteristics and needs within the Chinese context need to guide the development or tailoring of CKD self-management interventions. Emphasis should be placed on role management and emotional coping skills, while self-management components should be tailored by addressing the existing paternalistic patient–HCP relationship. The use of electronic health innovations can be an essential facilitator for implementation.

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Cultural Adaptation and Validation of the Malay Chronic Kidney Disease Self-Management Instrument (MCKD-SM)

10.21203/rs.3.rs-816054/v1 ◽

2021 ◽

Author(s):

Al Sawad Ayat Ali ◽

Soo Kun Lim ◽

Li Yoong Tang ◽

Aneesa Abdul Rashid ◽

Boon-How Chew

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Cultural Adaptation ◽

Self Efficacy ◽

Self Management ◽

Retest Reliability ◽

Disease Knowledge ◽

Management Behaviour ◽

Management Instrument ◽

Test Retest Reliability

Abstract Background: There is growing evidence that self‐management behaviour can improve outcomes for patients with chronic kidney disease (CKD). However, there are no measures available in Malay to effectively assess self-management of CKD. The aim of this study was to translate, culturally adapt, and validate the Malay Chronic Kidney Disease Self-Management (MCKD-SM) for Malay-speaking health professionals and patients. Methods: This study was carried out in two phases: translation and cultural adaptation, and validation. Instruments were translated from English to Malay then adapted and validated in a sample of 337 patients with CKD stages 3-4 attending a nephrology clinic in a tertiary hospital in Malaysia. Construct validity was evaluated by exploratory factor analysis. Reliability of the instrument was assessed by internal consistency and test‐retest reliability. The correlations between MCKD-SM and kidney disease knowledge, MCKD-SM and self-efficacy were hypothesised a priori and investigated. Results: The Malay version of the Chronic Kidney Disease Self-Management instrument has 29 items grouped into three factors: “Understanding and Managing my CKD”, “Seeking Support” and “Adherence to Recommended Regimen”. The three factors accounted for 56.3 % of the total variance. Each factor showed acceptable internal reliability with Cronbach’s α from 0.885-0.960. 2-week intra-rater test-retest reliability intraclass correlation coefficient values for all items ranged between 0.938 to 1.000. MCKD-SM scores significantly correlates with kidney disease knowledge (r = 0.366, p < 0.01) and self-efficacy (r = 0.212, p < 0.01).Conclusion: The Malay version of the CKD-SM was found to be a valid and reliable patient‐reported outcome measure of pre-dialysis CKD self-management behaviour in the Malay-speaking population.

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Patient activation with knowledge, self-management and confidence in chronic kidney disease

Journal of Renal Care ◽

10.1111/jorc.12142 ◽

2015 ◽

Vol 42 (1) ◽

pp. 15-22 ◽

Cited By ~ 18

Author(s):

Michelle L. Johnson ◽

Lani Zimmerman ◽

Janet L. Welch ◽

Melody Hertzog ◽

Bunny Pozehl ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Patient Activation ◽

Self Management

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Illness perception in patients with chronic kidney disease and kidney failure: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2020-042298 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042298

Author(s):

Jia Hwei Ng ◽

Jaclyn Vialet ◽

Michael A Diefenbach

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Scoping Review ◽

Kidney Failure ◽

Medical Information ◽

Illness Perceptions ◽

Demographic Data ◽

Self Regulation ◽

Illness Perception ◽

Regulation Model

IntroductionPatient education is a crucial component in the management of chronic kidney disease (CKD); however, many education programmes do not tailor to patients’ disease-related belief and emotional reactions. According to Leventhal’s self-regulation model, such beliefs and reactions, known as illness perceptions, are a part of patients’ understanding of their disease and treatment-related actions. The existing research of illness perception in the field of nephrology has been heterogenous in terms of study outcomes and in study population; and the evidence of how illness perceptions affect behavioural and decisional outcomes is limited. This scoping review aims to map and summarise the evidence of published literature on illness perception among patients with CKD not yet treated by dialysis and kidney failure.Methods and analysisThis study bases its approach on Joanna Brigg’s Institute Guidelines on scoping review methods. The search strategy was developed together with a medical information specialist. Searches will be performed on acceptance of publication in the following databases: PubMed, EMBASE, PsycINFO via Ovid, Scopus and the Cumulative Index to Nursing and Allied Health Literature. Searches will be run without incorporating a date restriction in order to capture content from the databases’ inception to present day. Search terms including ‘illness perception’, ‘kidney disease’ and ‘kidney failure’ will be screened in titles and abstracts. Two independent researchers will screen the abstracts and full text for full eligibility. We will include studies focusing on illness perception of patients with CKD with estimated glomerular filtration rate <60 mL/min/1.73 m2, kidney failure or recipients of kidney transplant. We will exclude patients <18 years of age, patients with acute kidney injury and non-English articles. All demographic data, study design and study findings will be collected and analysed using a data abstraction tool.Ethics and disseminationThis study does not require internal review board approval. We will present the findings of this scoping review in a peer-reviewed journal.

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The effectiveness of nurse-led self-management support program for people with chronic kidney disease stage 3-4 (CKD-NLSM): Study protocol for a randomized controlled trial

Science Progress ◽

10.1177/00368504211026159 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110261

Author(s):

Al Sawad Ayat Ali ◽

Soo Kun Lim ◽

Li Yoong Tang ◽

Aneesa Abdul Rashid ◽

Boon-How Chew

Keyword(s):

Kidney Disease ◽

Controlled Trial ◽

Self Management ◽

Control Group ◽

Management Support ◽

Disease Knowledge ◽

Management Intervention ◽

Randomized Controlled ◽

Ckd Stage ◽

Management Behaviors

The complexity of chronic kidney disease (CKD) and its treatments have made self-management behaviors inevitably challenging. However, supplementing education with self-management skills may improve numerous health outcomes in people with nondialysis CKD. This study protocol describes a randomized controlled trial (RCT) aimed to evaluate the effects of a nurse-led self-management support program as an intervention for kidney disease knowledge and CKD self-management behaviors among people with pre-dialysis CKD. In Phase 1, people with CKD stage 3–4 and their family members are involved in co-designing, development and pilot testing of a theory-based self-management intervention. In Phase 2, we perform a cross-cultural adaptation of the Kidney Disease Knowledge Survey, CKD Self-Management and Self-efficacy for Managing Chronic Disease questionnaires. In Phase 3, a parallel RCT will be conducted to evaluate the intervention where 154 participants with CKD stage 3–4 will be randomly assigned to either the intervention ( n = 77) or control group ( n = 77). The intervention group will receive 6-week self-management program from a nurse-coach in addition to standard usual care, while the control group will receive only standard usual care. Outcome measures include kidney disease knowledge, CKD self-management behavior, self-efficacy, quality of life, blood pressure control and adherence to CKD diet as indicated by 24-h urine urea nitrogen, 24-h urine sodium and net endogenous acid production. Data will be collected at baseline and 12-week post-baseline. The between- and within-group intervention effects will be estimated using the Generalized Estimating Equations. The self-management intervention offers strategies to delay CKD progression and to encourage motivation to better self-manage at home. This study integrates self-management education and psychosocial support with culturally relevant scenarios, and evaluates important self-reported and objective outcomes. Clinical Trials Registration: www.ClinicalTrials.gov , identifier: NCT03974646.

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Factors influencing self‐management among Indonesian patients with early‐stage chronic kidney disease: A cross‐sectional study

Journal of Clinical Nursing ◽

10.1111/jocn.15930 ◽

2021 ◽

Author(s):

Ira Suarilah ◽

Chiu‐Chu Lin

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Early Stage ◽

Cross Sectional Study ◽

Self Management ◽

Sectional Study ◽

Cross Sectional ◽

Factors Influencing

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Pharmacist-Led Collaborative Medication Management for the Elderly with Chronic Kidney Disease and Polypharmacy

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084370 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4370

Author(s):

A Kim ◽

Hayeon Lee ◽

Eun-Jeong Shin ◽

Eun-Jung Cho ◽

Yoon-Sook Cho ◽

...

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Medication Management ◽

Medication Use ◽

Potentially Inappropriate Medications ◽

Management Service ◽

Ckd Stage ◽

The Impact

Inappropriate polypharmacy is likely in older adults with chronic kidney disease (CKD) owing to the considerable burden of comorbidities. We aimed to describe the impact of pharmacist-led geriatric medication management service (MMS) on the quality of medication use. This retrospective descriptive study included 95 patients who received geriatric MMS in an ambulatory care clinic in a single tertiary-care teaching hospital from May 2019 to December 2019. The average age of the patients was 74.9 ± 7.3 years; 40% of them had CKD Stage 4 or 5. Medication use quality was assessed in 87 patients. After providing MMS, the total number of medications and potentially inappropriate medications (PIMs) decreased from 13.5 ± 4.3 to 10.9 ± 3.8 and 1.6 ± 1.4 to 1.0 ± 1.2 (both p < 0.001), respectively. Furthermore, the number of patients who received three or more central nervous system-active drugs and strong anticholinergic drugs decreased. Among the 354 drug-related problems identified, “missing patient documentation” was the most common, followed by “adverse effect” and “drug not indicated.” The most frequent intervention was “therapy stopped”. In conclusion, polypharmacy and PIMs were prevalent in older adults with CKD; pharmacist-led geriatric MMS improved the quality of medication use in this population.

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Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glz294 ◽

2019 ◽

Vol 75 (3) ◽

pp. 517-521

Author(s):

Ryon J Cobb ◽

Roland J Thorpe ◽

Keith C Norris

Keyword(s):

Older Adults ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

The United States ◽

Health And Retirement Study ◽

Disease Epidemiology ◽

Lower Egfr ◽

Everyday Discrimination ◽

Retirement Study

Abstract Background With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults. Methods The data were from 10 973 respondents (ages 52–100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function. Results Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = −1.35, p < .05), and while attenuated, remained significant (B = −0.79, p < .05) after further adjustments for clinical, health behavior, and socioeconomic covariates. Conclusions Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults.

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