Training for peer mentorship programs among patients with dialysis requires flexibility
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Key takeaways:
- Schedule accommodation was the main challenge of mentor training.
- Mentors demonstrated high knowledge scores following training.
Patients on dialysis who underwent training to become a peer mentor reported a need for flexible training schedules, according to data published in Kidney Medicine.
With the accommodations made, mentors performed well on tests after attending training.
“Peer mentorship is feasible among patients with kidney failure, and has shown to improve adherence to dialysis, informed decision-making and satisfaction among persons receiving mentorship,” Ladan Golestaneh, MD, MS, a nephrologist from Montefiore Medical Center, and colleagues wrote. They added, “However, success of training to impart knowledge or self-efficacy has not been previously described, nor has there been a robust evaluation of feasibility and acceptability of training to peer mentors.”
Golestaneh and colleagues previously conducted the PEER-HD study to determine the effectiveness of a peer mentorship program to reduce hospitalizations in an urban “racial-ethnic minority patient” population. They conducted an evaluation of the feasibility, efficacy and acceptability of the mentor training program. Data were derived from baseline clinical and sociodemographic questionnaires from mentor participants using dialysis.
Mentors attended four 2-hour training modules, then completed surveys to demonstrate kidney knowledge, self-efficacy and an 11-item survey of trainer performance and module content. Results of these surveys were used to measure feasibility, efficacy and acceptability, which served as the primary outcomes.
Among the 14 of 16 mentors who completed the training, 33% were of categorized as being of Hispanic descent. Scheduling was the most common challenge of the training program, due to mentors’ own dialysis appointments and kidney health.
“We overcame some of these challenges by offering schedules that accommodated both in-center dialysis schedules and allowed ample opportunity for make-up sessions with both in-person and virtual instruction,” Golestaneh and colleagues wrote.
Following training, mentors showed consistently high knowledge scores in test results, and there was no change in self-efficacy scores. Mentors rated the program with favorable acceptability, with mean of 3.43 to 3.93 on of a 0 to 4 scale. Four served as the most favorable rating.
“When asked what the most helpful tool in the training program was, most answered enhancement of communication skills, while the least helpful topic covered seemed to be redundancy of the dialysis-specific knowledge. Participants referred to specific topics, such as dietary restrictions, transplant or communication with staff and skills on how best to cope with dialysis, when asked what was missed in the training.” Golestaneh and colleagues wrote. They added, “Moreover, our training program uniquely instructed mentors on how best to use their dialysis facility resources to manage their fluid, access, adequacy and minor infection care (eg, upper respiratory tract). In this way, the training aimed to empower and equip patients as coached by their mentors to coordinate more efficient use of resources to avoid hospitalizations.”
Perspective
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Wael Hussein, MBBS, MSc, MRCPI
Dialysis is a life-sustaining treatment for patients with end-stage kidney disease. However, this life-saving treatment comes with physical, emotional, social and financial burdens that negatively impact patients and their families. Dialysis is associated with high mortality rates, increased risk of hospitalization and poor quality of life. Moreover, a large proportion of patients are not satisfied with decision-making related to important aspects of their dialysis care including, for example, modality choice.
These factors highlight the need for innovative interventions to improve patients' outcomes and experiences. One promising intervention is peer mentorship, which offers the potential to improve goal setting, improve decision-making and self-management and patient activation. Despite its promise, there is currently a lack of data regarding best practices in rolling out these programs, including data on mentor training.
The PEER-HD study is a pragmatic, multicenter, randomized controlled trial that aims to test the effect of peer mentorship on hospitalizations among a racial-ethnic minority population. Carried out in the Bronx and Nashville, the study has two phases: the first is focused on recruiting and preparing mentors, and the second on implementing mentorship and evaluating the effect on hospitalizations.
Findings from phase 1 of the PEER-HD study were recently published. The investigators successfully recruited and trained 14 mentors and published their evaluation of the training program. The training program was flexible, offering different schedules and platforms (in-person/virtual, group/individual) to accommodate mentors’ needs, resulting in full completion of all modules by all but two mentors, who dropped early during the program. There were no statistically significant changes in mentor knowledge or self-efficacy. It was not clear what the reason behind this lack of improvement was, but the small sample size may have contributed to it. Mentors evaluated the training modules favorably. These modules focused on dialysis-related knowledge and developing mentorship and self-efficacy skills. Role-playing during sessions was vital to support communication and mentorship skills.
The investigators are to be commended for describing the training program and sharing their experience in implementing it, particularly as it was run during the COVID-19 pandemic. Phase 2 of the PEER-HD study is underway and will report on the effect of peer mentoring on ED visits and hospitalizations as primary outcomes and on perception of social support and self-efficacy, and dialysis adherence among mentees.
The pivot to virtual media (phone and video) for mentor training was influenced by the pandemic realities. Phase 2 of this study relies on phone calls for peer support. Similar adaptations for mentor training were made to another peer mentoring study, led by a team from the American Association of Kidney Patients (AAKP), Emory University and Kaiser Permanente Georgia. The aim of this project is to develop and implement a peer mentoring system that expands the AAKP ambassador program. The National Kidney Foundation peer mentoring program (NKF PEERS; www.kidney.org/peers) is completely telephonic in relation to peer-to-peer interactions. It has to be noted that face-to-face interactions, at least initially, are rewarding but logistically challenging. On the other hand, virtual meetings may limit interest among new mentees.
Dialysis, being a chronic condition with significant impact on patients' lives, is well-suited for peer mentoring. Multiple stakeholders, including providers, regulators and patient groups, need to work together to make these programs available and of high quality. Standardized mentor training programs, standard quality metrics for mentors and mentor-mentee interactions, and methods to increase engagement and retention of mentors are required components. While developing these standards, it is essential to maintain flexibility, which is integral to individualization, particularly for an intervention that touches the human experience.
References:
- Bennett PN, et al. Kidney Medicine. 2022;doi: 10.1016/j.xkme.2022.100529..
- Bennett PN, et al. Semin Dial. 2018;doi: 10.1111/sdi.12703
- Collins K. NKF peers mentoring program: an overview and lessons learned. J Nephrol Soc Work. 2016;40:25-33.
- Daniel SC, et al. Quality of Life Research. 2021; doi:10.1007/s11136-020-02684-2.
- Ghodsian S, et al. BMC Nephrology. 2021;doi:10.1186/s12882-021-02269-2.
- Golestaneh L, et al. Feasibility of a peer mentor training program for patients receiving hemodialysis: an educational program evaluation. Kidney Medicine.
- Golestaneh L, et al.. BMC Nephrology. 2022;doi: 10.1186/s12882-022-02701-1 .
- Hussein WF, et al. Am J Kidney Dis. 2022;doi:10.1053/j.ajkd.2021.07.015
- Lea J. Enhanced patient engagement to improve patient-centered outcomes among chronic kidney disease (CKD). American Association of Kidney Patients;2023.
- Subramanian L, et al. Am J Kidney Dis. 2019;doi:10.1053/j.ajkd.2019.01.030.
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