Education and decision support improve outcomes in urgent dialysis: A randomised trial.

Abstract

This study aimed to develop and evaluate a structured Decision Tree-Supported Education Program (DTSEP) for patients initiating dialysis under emergency conditions, with outcomes including treatment satisfaction, adherence, self-care, quality of life, depression, and clinical and biochemical parameters. A randomized controlled trial was conducted with 86 patients who began urgent renal replacement therapy. Participants were randomly assigned to either a Dialysis Education Program (DEP, n = 43) or a DTSEP group (n = 43). Both groups received structured training during two education sessions, while the DTSEP group completed an additional third session incorporating a decision tree application. Data were collected using clinical measures and validated instruments, including the Patient Assessment of Chronic Illness Care Scale, the Self-Care Ability of Chronic Dialysis Patients Assessment Scale, the EQ-5D Quality of Life Scale, and the Patient Health Questionnaire (PHQ-9). Patients in the DTSEP group demonstrated significantly improved laboratory and clinical outcomes, higher adherence and satisfaction scores, greater self-care competence, better chronic illness management, and enhanced quality of life compared to the DEP group. Depression scores decreased significantly in the DTSEP group. Decision support combined with structured education is more effective than education alone for patients beginning dialysis urgently, improving both clinical and psychosocial outcomes. This study provides preliminary support for multidimensional training and decision support designed to effectively improve patient outcomes, suggesting that this approach may be used for similar patient groups.