American Journal of Kidney Diseases, August 2021
Authors: Wael F. Hussein, Paul N. Bennett, Graham Abra, Emily Watson, Brigitte Schiller
Patient activation, the measure of patients’ readiness and willingness to manage their own health care, is low among people on in-center hemodialysis (HD), exacerbated by how passively patients receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual burden and costs to the healthcare system. To improve patient activation, we need to embrace a “patient-first” approach and combine it with ways to equip patients to thrive with self-management. This requires changes in the training of the healthcare team, as well as changes in the delivery care models, promoting interventions such as health coaching and peer mentoring, while leveraging technology to enable self-access to records, self-monitoring, and communication with providers. We also need healthcare policies that encourage a focus on patient-identified goals, including more attention to patient-reported outcomes. In this article, we review the current status of patient activation in dialysis patients, outline some of the available interventions, and propose steps to change the dynamics of the current system to move towards a more active role for patients in their care.