Title: Facilitation of Self Management in a Haemodialysis Unit: An Evaluation
Funder: Department of Health (England)

Abstract: Background Haemodialysis patients must adhere to multiple dietary and fluid restrictions, but find this difficult(1). Failing to comply with these restrictions can cause a host of clinical complications (11). Patients on haemodialysis also commonly experience psychological problems such as depression(2). Self-management facilitation has been shown to reduce similar problems in other chronic illnesses(6,8,23,24,25). Currently, dialysis patients generally only receive a one off educational programme focused on modality choice before initiation of dialysis. The aim of the study is to evaluate the impact of facilitating on-going self management in this group of service users on the service users and staff. Given the complex nature of the intervention planned, an action research approach will be used. Aims The duration of the proposed study will be 36 months. The aim of the study is to assess the potential benefits for patients being treated in a haemodialysis unit that receives ongoing self-management facilitation. The aims of the project are built round an action research cycle of: - Developing an action plan: working with service users and staff to source resources and develop an intervention - Intervening and observing the intervention: through changes in quantitative measures, interviews and focus groups, documentation of field notes and critical incidents - Evaluation and forward planning: to bring all the materials together, identifying enablers and barriers to self-management, and produce a roadmap for implementation in other centres. Plan of Investigation The self-management facilitator will be a nurse who is also the action researcher, supported by a research team. The study will take place in one renal service treating 400 service users. Using an action research paradigm, the research team will draw upon a mixed methodology to implement and evaluate the 3 phases outlined above. The first phase will define practical methods to implement strategies to promote self-management with the support of all involved in care. The second phase will observe implementation of the strategies through: collection of clinical and psychological measures, focus groups and interviews, and field notes. The last phase will bring all the evidence together (triangulation) producing a roadmap and documentation to support implementation in other centres. Potential Impact Chronic Kidney disease is a large and growing problem, placing a large burden on the NHS (21,22). There is evidence that facilitating self-management in chronic illness can empower service users and improve their treatment adherence, as well as their physical and psychological wellbeing (6,8,23,24.25). By demonstrating how self-management can be practically facilitated within a service the study will have a large impact on key indicators of service performance. Through promotion of self-management the study can promote treatment adherence, improving the quality of life and other clinical outcomes, and potentially reduce unnecessary resource use by this group of service users. Finally the study is designed to enable other services to implement similar changes to service.???


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: RENAL AND UROGENITAL