Peer mentor aids end-of-life planning: study

NEW YORK (Reuters Health) – Peer mentoring, in which
trained patients educate other patients, offers a culturally
sensitive way to inform dialysis patients about their condition
and treatment options, new research suggests.

Within cultural groups with oral rather than written
traditions, this person-to-person approach appears to encourage
discussion about living wills (advance directives) and
end-of-life decision-making.

Because of the high death rate among dialysis patients,
death and end-of-life discussions are critically important for
the dialysis community, Erica Perry, from the National Kidney
Foundation of Michigan in Ann Arbor, and colleagues note in the
American Journal of Kidney Diseases this month.

They explored the impact of peer mentoring compared with
standard printed materials on end-of-life decision-making in
203 dialysis patients.

The mentors attended a workshop on advance directives, and
received training through role-playing and direct instruction
on communicating about end-of-life planning.

During the study, patients assigned to peer intervention
were contacted eight times by mentors to talk about coping with
chronic illness, the impact on family, and eventually the value
of completing a living will.

Compared with standard printed materials, the use of peer
mentoring significantly increased the odds that advance
directives would be completed (12 percent vs. 35 percent), the
authors report.

The benefits were most pronounced in African American
subjects for whom significant improvements in comfort
discussing such directives, subjective well-being, and anxiety
levels were also seen. By contrast, these effects were not seen
among white subjects. However, printed materials seemed to
reduce suicidal thoughts among whites.

“Peer mentoring in dialysis units appears to address
differences in cultural value systems, allay anxiety, and
promote discussion and acceptance of advance directive planning
and, to some degree, death itself,” the authors conclude.

SOURCE: American Journal of Kidney Disease, July 2005.