Chronic Disease Self Management Programs - Examining the feasibility of introducing a patient centred care model to dialysis patients
To successfully navigate chronic kidney disease (CKD), patients must become experts in symptom monitoring, nutrition, medication, dialysis, life-style adaptation and negotiating relationships with health-care professionals. Many patients do not master these concepts. Further, health-care professionals often interact with patients in a paternalistic fashion, diminishing patient participation as equals in their own health care.
This project aimed to evaluate the suitability of chronic disease self-management (CDSM) models in CKD. It was hoped patients would be empowered to participate more fully in health-care decisions and staff would gain insight into the patients’ lived experience of managing chronic illness.
Two CDSM tools were evaluated via group discussions: the Flinders Model of Chronic Condition Self-Management, and the Stanford University CDSM Program.
The Stanford program consists of weekly group meetings, targeting patient skills to cope with chronic illness. Topics include relaxation techniques and action plans for change. The program was promising but required adaptation for CKD, particularly with its nutritional advice.
The Flinders Model consists of an interview, questionnaire, feedback and collaboration with the patient to illuminate problems and jointly plan improvement strategies. The NWDS pilot included 10 dialysis patients (7 HD and 3 PD). After 4 weeks almost all patients achieved at least modest progress (average 40%) towards their goals. Both patients and staff found the model rewarding.
Both the Stanford and Flinders model have merit, and ideally could be used to complement each other to empower patients and help staff remember the patient’s point of view is a vital ingredient in quality care.