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Less may be more when it comes to counseling patients on how to prevent kidney stones, according to new findings presented at the National Kidney Foundation's 2014 Spring Clinical Meetings.
“You have to prioritize your recommendations,” said Dr. R. Allan Jhagroo, a professor in the department of urology and the department of medicine, division of nephrology at the University of Wisconsin in Madison, an author of the new study. “Too much can be overwhelming.”
Nutrition therapy is an important way to prevent patients who have a tendency to form kidney stones from developing them again and again. To investigate how well patients recalled recommendations made to them about diet, Dr. Jhagroo and his colleagues surveyed 17 men and women who had received nutrition counseling during the past four months.
The patients had been given an average of three recommendations each, along with written handouts describing their nutrition plan. The most common recommendations included eating at least five servings of fruits and vegetables a day; increasing fluid intake by a specific amount; and increasing or changing the distribution of calcium intake throughout the day.
Only thirty-five percent of the patients had perfect recall of all the recommendations they were given. Among patients given three or more recommendations, 28 percent remembered all of them. In contrast, among patients given only one or two recommendations, 50 % remembered everything they were told. While 24 percent of the patients said they had difficulty following the recommendations, 87 percent said they found the recommendations “acceptable,” and all said they would be willing to keep trying to follow them.
Dietary recommendations must be made on a patient-by-patient basis, depending on several factors including the type of stones a patient tends to form, Dr. Jhagroo noted. “If you give one or two recommendations, you're more likely to have people remembering what you said and following what they were asked to do,” he said.
“Evaluating how to best educate and motivate people to make lifestyle changes and maintain compliance with prescribed medical therapies is critical to preventing disease and improving health outcomes,” said Beth Piraino, MD, President of the National Kidney Foundation.
“How clinicians provide the instructions to their patients is important to adherence with prescribed treatment such as diet regimen to reduce kidney stone formation,” Piraino added. “Patient understanding is improved when the information is provided in a simple, digestible manner. Clinicians need to develop methods to provide this information incrementally to allow better comprehension and adherence, rather than trying to provide all of the information in a single office visit.”