Counseling on high phosphorus is probably one of the most time consuming tasks, second only to improving albumin levels. We know there are many reasons why phosphorus levels are high: competing values, depression, financial, side effects, missed treatments…the list could go on…and on. Many times we do phosphorus education verbally and written, ask if there are any questions- and then think our work should be done. However, often there isn’t any improvement, and we end up having the same conversation, month after month, year after year.
I started using this tool in patients with chronically high phosphorus to find out if there was some lack of understanding. What I found was surprising- the majority of patients couldn’t recall 90% of the answers. I was disheartened, until I realized that this tool was giving me exactly what I needed: an opportunity to be more effective. I had to take a step back and evaluate my teaching style as well as other reasons why they might not remember ANYTHING.
One thing I remembered a nurse practitioner telling me, was that because the patients have blood pressure fluctuations during dialysis, it can impact their short term memory. There are also alot of distractions in a dialysis clinic- visual and auditory. This means it really isn’t an ideal learning environment, even if they aren’t hearing impaired, and if they are, that can be a significant challenge. Also, when someone first starts dialysis, they are given ALOT of information, and even if you repeat the education, they might still be adjusting and phosphorus may be lower on their to do list for a variety of reasons.
Truthfully, if phosphorus was important, then the patient will find a way to overcome whatever barrier- they will tell you the co-pay is too high and work with you to fill out the paperwork for assistance, they will let you know if they are having side effects from their binder and need to try a different one…they will figure it out. But sometimes there are just too many other things going on. So that is where this tool comes in. You can allow them to teach back and you can see what they don’t know- then find out why? Is a chair-side discussion uncomfortable for them because they can’t hear well? Are they more concerned about their wife’s health? Do they feel like there are so many things wrong, phosphorus is just a drop in the bucket? Are they too tired or depressed to make phosphorus a priority?
Of course you will have patients who aren’t interested in making changes, however there will be others who you will be able to better help because you found out what they didn’t know and why- and then tailored an intervention to meet their individual needs. This builds a better relationship of trust AND improves the patient’s health AND hopefully saves you from fruitless doing more phosphorus educations.