224 found suboptimal communication between patients and HCPs to be an issue, especially regarding the improvement of the patients’ disease awareness and knowledge. Third, we identified many barriers that go beyond knowledge, and hinder patients to self-manage lifestyle on the long-term. In our systematic review, only 14 of the 48 included studies focused on a population with mild to moderate CKD (Chapter 2). Due to this, there is a dearth of evidence regarding promising targets to prevent the onset or further progression of kidney disease. This aligns with previous conclusions that interventions targeting self-management or lifestyle in earlier stages of the disease are scarce, in CKD but also in other chronic diseases[12]. A likely explanation is that healthcare systems often have a more short-term, disease and cost-focused perspective. Preventive interventions may not yield immediate cost savings or outcomes, but can lead to significant long-term benefits in terms of disease prevention and management. Research funding often follows this health care model, leading to more studies in later stages of the disease, where complications and hence study endpoints can be anticipated to occur within the limited timeframe of the study. Our results emphasize the need to develop more interventions with the potential to prevent kidney disease or slow its progression, especially given the increasing prevalence of CKD worldwide[8,9]. We found general practitioners often fail to adequately explain the meaning of having CKD and self-management, whereas HCPs in hospitals often provide too much or too detailed information. Both approaches result in suboptimal communication and contribute to lower patients’ awareness and knowledge about CKD and self-management (Chapters 3 and 4). Other studies already have found that LHL was associated with lower disease awareness and knowledge among patients, but these studies considered this to be due to the individual patient’s traits[13–15]. Our combined findings add an important perspective by indicating there is a discrepancy between the informational needs of patients with LHL and the communication approach of HCPs. This is confirmed by studies showing there is suboptimal patient-professional communication about kidney disease in all CKD health settings, but especially in primary care[16,17]. We hypothesize that shortcomings in the communication of HCPs might affect
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