Self management of haemodialysis for End Stage Renal Disease: a systematic review.

Background: Exploring self management in End Stage Renal Disease is extremely important for patients as they encounter several challenges including ongoing symptoms, complex treatments and restrictions, uncertainty about life and a dependency on technology, all of which impact upon their autonomy particularly after commencement of haemodialysis.

Objective: To summarise the effects of nursing interventions which effect selfmanagement of haemodialysis for patients with End Stage Renal Disease.

Search Strategy: Search terms were chosen after reviewing text words and MeSH terms in relevant articles and databases. An extensive search of the literature from 1966 to June 2009 was conducted across a range of health databases including Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science. Further studies were identified from reference lists of all retrieved studies.

Selection Criteria: We considered randomised controlled trials that compared interventions to improve self management of haemodialysis in patients with ESRD. In the absence of RCTs, comparative studies without randomisation as well as before and after studies were considered for inclusion.

Methodological Quality: Study reports selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using the standardised critical appraisal instruments for the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information package (SUMARI).

Data Collection And Analysis: Data was extracted using the JBI data extraction tool for evidence of effectiveness independently by pairs of review authors. The evidence was reported in narrative summaries due to heterogeneity of the interventions of the studies.

Results And Conclusions: Five randomised controlled trials were included in the review. Overall, the evidence found that psychosocial and educational interventions influenced self management of haemodialysis in this patient population.

Implications For Practice: There is evidence to suggest that implementing the following interventions may be effective in improving self management for patients with End Stage Renal Disease undergoing haemodialysis.

Implications For Research: The design and interventions of future studies with statistically significant results should be replicated to allow for study comparisons, data analyses and the translation of results into clinical practice. There is a need for randomised controlled trials to include longer term, follow up data collection of the included interventions to show effectiveness of interventions over time.