Effectiveness of patient education on adherence to treatment regimen and quality of life in hemodialysis patients: a systematic review and meta-analysis.

Abstract

Introduction: Hemodialysis constitutes a protracted therapeutic intervention for renal failure, characterized by symptoms that exert a considerable toll on quality of life owing to their intensity and frequent recurrence. Patient education and engagement has been shown to enhance adherence, thereby improving treatment effectiveness and quality of life. The objective of this systematic review was to assess the effectiveness of patient education on improving adherence to treatment and enhancing quality of life among individuals undergoing hemodialysis.

Evidence acquisition: The systematic review and meta-analysis followed PRISMA's Preferred Reporting Item for Systematic Review and Meta-Analysis guidelines. The studies were evaluated utilizing the Joanna Briggs Institute methodology. The search utilized several databases including PubMed, CINAHL, Ovid, Wiley Online Library, Springer Link, and Google Scholar. Studies that specifically examined treatment adherence encompassing aspect such as fluid restriction, dietary modification, medication usage, electrolyte balance, and interdialytic weight management) as well as those assessing quality of life were included in this review.

Evidence synthesis: A total of 15 studies met the inclusion criteria. The studies explored adherence to various facets of treatment including fluids and electrolytes management (potassium, phosphate, creatinine level), medication usage (compliance with prescribe medication), dietary practices (adaptation according to disease and hemodialysis requirement), interdialytic weight management, and quality of life. Seven of these studies focus on investigating the quality of life, while the remaining eight examined specific components of treatment adherence. Due to the variation in methods, the results are described narratively. A quantitative synthesis was conducted using Revman 5.0 to assess the impact of educational intervention. This meta-analysis evaluated the pooled effects of adherence to fluids, electrolytes (creatinine), diet, and quality of life. A significant improvement is shown in fluid adherence (MD=35.18, 95% CI: 22.35, 48.0) (overall effect Z=5.38, P<0.0001), dietary modification (MD=37.50, 95% CI: 24.65, 50.35) (Overall effect Z=5.72, P=0.0001), and quality of life (MD=8.50, 95% CI: 4.50, 12.50, (overall effect Z=4.17, P=0.0001). However, no significant effect is observed on the creatinine level (MD=-0.50, 95% CI: -1.38, 0.38) (Z=1.12, P=0.026). The observed level of heterogeneity ranged from low to moderate.

Conclusions: Hemodialysis impacts various aspects of patients' lives. This systematic review shows that nursing education and behavior monitoring in patients undergoing hemodialysis contributes to improving their adherence to treatment and quality of life. The evaluated pooled effect and mean difference in meta-analysis findings shows that the educational interventions improve adherence to fluids and diet, as well as maintain creatinine balance and enhance quality of life.