85 Recommendation From theme(s): Description of the problem Strategy to improve Recommendations related to optimize the patients’ understanding Improve CKD awareness in earlier stages Patients: CKD elusiveness (T1) HCPs: Health care barriers (T3) Patients are often unaware of the existence and seriousness of CKD. GPs pay limited attention to CKD and mainly explain it as ‘a value from the lab’ without teaching self-management skills. Educate patients about the meaning of CKD, long-term risks, the relation with co-morbidities and lifestyle. Simplify information and check understanding Patients: Suboptimal uptake of knowledge (T2) HCPs: Lacking effective strategies (T2) Information is mainly provided orally or with (simple) text. This is not always suitable for patients with LHL. Patients’ understanding of information is not consistently checked. Provide simple information and use images, video’s and animations during education. Also visualize CKD lab values (with graphs). After explanation HCPs should explicitly ask patients to repeat information to check understanding. Provide practical step-wise guidance Patients: Suboptimal uptake of knowledge (T2), Not taking a front-seat role (T3) HCPs: Lacking effective strategies (T2) Patients perceive information as overwhelming or selfmanagement as unfeasible. They struggle to translate advices into daily life self-management. HCPs focus too much on medical theory and the aims of treatment, leaving out ‘the steps in between’. They think information is often too much. HCPs should focus consultations on one or two main topics, instead of discussing many. For these topics, they should provide step-wise advice and reflect during the next consultation if the patient succeeded. Recommendations to optimize the patients’ long-term self-management Motivate using life aims instead of health aims Patients: Maintaining change (T4) HCPs: Lacking effective strategies (T2) HCPs often motivate by emphasizing the importance of ‘being healthy’, while patients with LHL see no or only shortterm health benefits. For them life aims seem to have higher potential to improve self-management Apply consultation strategies aiming to truly understand what drives patients in their daily lives. Translate these drives with the patient into treatment or life aims to support self-management and provide rewards. Target barriers of patients with LHL Patients: Maintaining change (T4) HCPs: Lacking effective strategies (T2), Health care barriers (T3) Patients mention multiple barriers for self-management, such as resignation, negative emotions and socio-economic problems. HCPs pay limited attention to these self-management barriers. Apply strategies to truly understand the barriers hindering the patients to change and maintain self-management. Translate these barriers into solutions, in cooperation with the patient, to overcome them. Involve the social network Patients: Not taking a front-seat role (T3), Maintaining change (T4) HCPs: Lacking effective strategies (T2) According to both the patients and the HCPs the social network can either support or counteract self-management. Involvement of the social network in the treatment is often insufficient. Involve the social network better by inviting them for consultations, providing them with information and explaining them how they can support the patient without fully taking over responsibility. Recommendations to optimize the capabilities of the health care professional and health system Train the professional Patients: All themes (T1, T2, T3, T4) HCPs: Not recognizing HL problems (T1), Lacking effective strategies (T2) HCPs mention that they have problems to recognize HL problems and to truly understand the barriers of LHL patients. Patients and HCPs mention how strategies to improve selfmanagement not always meet the needs of patients with LHL. Train professionals to improve their abilities to recognize LHL and to apply patient-centred, tailored strategies to optimize self-management of patients with LHL. Incorporate the strategies mentioned above in the training. Table 3.3 Recommendations to optimize self-management of patients, derived from the results of the interviews and focus group discussions
RkJQdWJsaXNoZXIy MTk4NDMw