Peer mentor aids end-of-life planning: study (Reuters)

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.