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McCarthy, Kate
Languages: English
Types: Doctoral thesis
Subjects: RC
Introduction: People with established renal failure have difficult treatment decisions to make. Pre-dialysis education that leads to treatment decision-making has traditionally been ad-hoc, with programmes lacking a theoretical or evidence basis. The two key aims of this study were to design and deliver a theory-based predialysis educational intervention and explore individuals' pre-dialysis experience. Understanding the interplay, between the two, informed recommendations about how best to intervene to help people make good treatment decisions. The MRC Complex Intervention Framework guided study development but it has only been possible to address the first two phases within the scope of this thesis. Subsequent phases will be the focus of post-doctoral research.\ud \ud In the Theory Phase renal and long-term condition self-management literature was reviewed and self-efficacy theory was predominant in the literature. To address a significant gap identified in the literature the 'Retrospective Patient Views of Pre-Dialysis Education Study' sought 29 participants perspective of pre-dialysis educational components, using semi-structured interviews. Clinicians' advice and written information were valued and unplanned vicarious learning began to emerge.\ud \ud The Modelling Phase was founded on the theory phase findings. Firstly, a multidisciplinary and service user Participant Action Research study developed and delivered a self-efficacy theory-based pre-dialysis education intervention. The 'Service Users Pre-Dialysis and Treatment Decision–Making Experience Study' explored 20 participants pre-dialysis year, at 3 time points, resulting in 54 interviews. Findings were analysed using a grounded theory approach revealing that vicarious learning, the clinical setting and written information influenced treatment decisionmaking.\ud \ud Conclusion: Decision-making is dynamic and requires dynamic educational inputs tailored to individual needs. The 'Conceptual Model of Influences Impacting the Pre-Dialysis Journey' brings together the themes emerging from the grounded theory analysis. From this the original contribution to extending self-efficacy theory was developed, namely that vicarious learning and not mastery is key at this stage of individuals' care journey and this has not previously been recognised. The practical output from the research is the 'Pre-Dialysis Education Curriculum'. Recommendations for future research include an exploratory trial of self-efficacy theory-based pre-dialysis education.
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