The Effects of Nurse‐Led Coaching on Discordant Home Hemodialysis Patients
Bibliographic record
Abstract
INTRODUCTION: Home hemodialysis (home HD) has demonstrated superior clinical outcomes, improved quality of life, and enhanced treatment flexibility in comparison to 3 days/week in-center HDs. Nonetheless, some patients are discordant with their dialysis prescription and require a coaching program in order to maintain their normal lifestyle and ameliorate their illness behavior. OBJECTIVE: To describe the feasibility of conducting a nurse-led coaching program for discordant home HD patients and its effect on hospitalization and technique complications. METHODS: This is a retrospective single center observational cohort study of all prevalent home HD patients at University Health Network (UHN) from the period of January 2018 to December 2022. Demographic and clinical data were extracted from chart review. Nurses conducted weekly motivational interviewing with patients by phone, email, or in-clinic visits in the home HD unit to discuss the importance of being concordant to treatment and adapting the length and schedule of dialysis to avoid clinical complications. Health coaching was defined as patient-centered, incorporating patient-determined goals, self-discovery processes, accountability, and content information in the context of an ongoing helping relationship. Patients were categorized as concordant, concordant with agreement doing at least 75% of dialysis prescription, or discordant for those skipping/shortening home HD sessions without prior agreement with the clinical team. Comparisons were carried out using chi-squared or ANOVA testing as appropriate. p < 0.05 was defined as statistical significance. RESULTS: From 94 patients, 61 were concordant and 33 (35%) required coaching: 15 (16%) were concordant patients with agreement and 18 (19%) were discordant patients. Patients' demographics were summarized respectively for concordant patients, concordant with agreement, and for discordant patients. Age was 51 (37-61), 53 (47-61), 46 (35-54) [p = 0.102]; male gender was 62%, 53%, 72% [p = 0.519]; diabetes status was 21%, 7%, 6% [p = 0.219] and proportions of patients living alone were 13%, 7%, 17% [p = 0.739]. Patients requiring coaching tended to have a higher median time on home HD, 7.6 versus 4.3 years [p = 0.145] and tended to be less likely to be listed for kidney transplant [p = 0.174]. There were no differences in hospitalization and technique complications among patients who required coaching versus standard care. CONCLUSION: We demonstrated that it is feasible to provide coaching to home HD patients. Ongoing clinical testing of nurse-led coaching in home HD is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".