Teaching Treatment Options? Watch for Teachable Moments!

Okay, I am risking a cutback in my speaking invitations by sharing this topic with you, but, really, this info needs to be shared! In my reasonably humble opinion, we are largely doing treatment options education WRONG in the US. How? By focusing on treatment options.

I know. This doesn't make a lot of sense yet, but bear with me for a moment.

Treatment options for a serious illness, like cancer, are temporary aberrations (though they can certainly have lasting impact). No one does chemotherapy for years on end—just for weeks or months. Treatment for kidney failure is a lifestyle—yet we tend to educate people without ever even asking them about their lives!

The very first question we should be asking when someone needs to choose a dialysis option is, "What do you want your life to look like?" If this wording gets you a blank stare (and it may), delve in a bit and offer some specific examples. "What do you enjoy doing now that you want to be able to keep doing once you are on dialysis? Some people like to travel. Some really need to keep their jobs. Some have hobbies that are really important to them. How about YOU?"

Once you know what is most important to someone, you have a motivational "hook" you can use to make dialysis options more relevant. Then, if you understand the lifestyle impact of each option (if you don't, you can learn it in Help, I Need Dialysis!—and even get CE credits for it), you can tune your message so it gets through—and boost the chance that a patient will choose an option that is a good fit for him or her.

"Teachable moments" are a way of applying this same approach to in-center HD patients. A teachable moment is really just any lifestyle complaint. For example:

• I can't afford to pay my rent/mortgage, since I can't work!
• I'm afraid my partner will leave me, because my sex drive is gone.
• I'm depressed.
• I may as well throw away the food and just eat the box.
• I'm thirsty all the time!
• This itching is driving me crazy.

Each of these complaints offers a 1-minute chance to help patients see how PD, in-center nocturnal HD, short daily home HD, or extended home HD could impact their day-to-day lives for the better. If patients are not on the transplant list, these same teachable moments could also help them understand how their lives might look different with a new kidney.

Try it! And, let me know how it goes.