Self-management interventions for adult haemodialysis patients: a scoping review of randomized controlled trials

Abstract

Abstract Background Effective self-management is crucial for individuals undergoing haemodialysis to prevent complications, which can lead to morbidity and mortality. However, among this population self-management behaviours are often inadequate. To improve patient outcomes interventions that promote and enhance self-management behaviours are essential. Objective This study aimed to provide an overview of the current body of evidence from randomized controlled trials (RCTs) on self-management interventions for haemodialysis patients. First, we aimed to present the outcomes investigated, their corresponding measurement tools and the significant results of each study. Second, we examined the presence of various self-management components and activities within the interventions. We aimed to identify new, underrepresented, and absent self-management components and activities found in the interventions. Methods Following the scoping review process, a systematic literature search was conducted across six databases (MedLine All, Emcare, CINAHL, PsycINFO, Web of Science, Cochrane) to identify relevant studies. The search focused on RCTs involving adult haemodialysis patients. The review utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI) approach. The included studies were required to address either self-management theories or self-management support interventions. Data were synthesized using a tabular format. The findings were analysed using content analysis based on the self-management concept. Results Overall, fourteen articles from eight countries were included. The findings illustrate the broad thematic scope of self-management interventions. Most frequent intervention outcomes were ‘quality of life’, ‘self-management’ and ‘self-efficacy’. The most used instrument was ‘Strategies used by people to promote health’ for measuring self-care self-efficacy. All authors of the included studies reported significant results of the intervention. The content analysis identified commonly employed self-management components and activities for haemodialysis patients, such as ‘emotion regulation’, ‘medication adherence’, and ‘diet management’. It revealed underrepresented (infection control), absent (smoking cessation), and new (stress management) self-management dimensions. Conclusion This innovative scoping review represents the first comprehensive overview of self-management intervention outcomes, their measurements, and significant results while simultaneously highlighting the complex self-management components and activities that haemodialysis patients must navigate on a daily basis. The identified gaps and opportunities underscore important areas for future intervention development. Clinical trial number Not applicable.

Keywords

• Dialysis
• End-stage kidney disease
• Self-management
• Randomized controlled trials
• Scoping review