Peer monitoring, in which trained patients educate other patients, offers a culturally sensitive method of informing dialysis patients about their condition and treatment options, new research suggests. Within cultural groups with oral rather than written traditions, this person-to-person approach appears to encourage discussion about advance directives and end-of life decision-making.
“Acknowledging cultural differences and tailoring our approach could be powerful in enhancing trust and participation and decreasing potential disparities in healthcare outcomes,” lead author Erica Perry, from the National Kidney Foundation of Michigan in Ann Arbor, and colleagues note in the American Journal of Kidney Diseases for July.The researchers compared peer monitoring and standard printed materials in their ability to communicate information about advance directives to 203 dialysis patients. The mentors had attended a workshop on advance directives, and received training through role-playing and direct instruction on communicating about end-of-life planning.During the study, patients assigned to peer intervention were contacted eight times by mentors to talk about coping with chronic illness, the impact on family, and eventually the value of completing an advance directive.Compared with standard materials, the use of peer monitoring significantly increased the odds that advance directives would be completed (12% vs. 35%), the authors report.The benefits were most pronounced in African American subjects for whom significant improvements in comfort discussing such directives, subjective well-being, and anxiety levels were also seen. By contrast, these effects were not seen among white subjects. However, printed materials seemed to reduce suicidal ideation among whites.”Peer mentoring in dialysis units appears to address differences in cultural value systems, allay anxiety, and promote discussion and acceptance of advance directive planning and, to some degree, death itself,” the authors conclude. (Source: Am J Kidney Dis 2005;46:111-119: Reuters Health: Oncolink: July 2005.)