Language influences CKD awareness of patients
A mixed-effects models study showed the importance of diction and how it can influence chronic kidney disease awareness. Differing terminology impacted patients’ understanding of their condition and treatment options, researchers noted.
“Patient awareness of CKD in the health care setting is critical for engagement with clinicians about CKD education, which can facilitate healthy self-management behaviors to reduce progression or associated complications,” Chi D. Chu, MD, MAS, clinical research fellow in the division of nephrology at the University of California, San Francisco, and colleagues wrote. “In studies based in health care settings where CKD is diagnosed, patient unawareness of CKD may represent a failure of effective education or communication between clinicians and patients.”
According to Chu and colleagues, awareness of CKD has consistently been low, which prompted them to determine the association of wording used in study questionnaires with the prevalence of CKD awareness.
For this study, two independent reviewers extracted data from 23 articles on patient awareness of CKD status published to PubMed, MEBASE, Web of Science, PsycINFO and Sociological Extracts from 2004 to 2017. A third reviewer handled discrepancies in data extraction of study setting, years of data collection, criteria to define CKD, questions used, estimates of CKD awareness, study size and CKD awareness characteristics. The smallest study size involved 107 participants. Following data extraction, researchers used the Joanna Briggs Institute critical appraisal checklist to assess the risk of bias. They applied mixed effects models to determine the collective prevalence of CKD awareness. Chu and colleagues also used the Cochran’s Q test to assess heterogeneity.
The 32 articles used several different question wordings about CKD awareness. Individual studies yielded a CKD awareness of 0.9% to 94%, while overall awareness was 19.2%. The phrasing “kidney problem” produced the highest overall CKD awareness (58.7%) and “weak failing kidneys” delivered the lowest awareness (12.3%). Moreover, researchers found awareness was highest among patients from nephrology clinics (86.2%) but lowest in the general population (7.3%). Also, awareness increased with CKD severity.
The Joanna Briggs Institute assessment revealed a low overall risk of bias. However, the most common sources of bias included unclear or bias-prone sampling methods and failure to report response rates, according to Chu and colleagues. Also, they noted the significant heterogeneity found across the studies to be a major limitation.
“Going forward, reliable surveillance is contingent on identifying the most meaningful ways to ascertain CKD awareness, as well as developing ways to leverage awareness to advance patient engagement and health — a scenario unlikely to be realized if studies and surveillance of CKD awareness continue to rely on questions using insensitive wording and an incomplete understanding of the multiple determinants affecting awareness,” Chu and colleagues wrote.
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