Abstract: TH-PO277
Numeracy Relates to Communication and Clinical Outcomes in ESKD
Session Information
- Hemodialysis and Frequent Dialysis - II
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Nair, Devika, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Wild, Marcus G., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Fissell, Rachel B., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Wallston, Ken, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
Group or Team Name
- Behavioral Medicine in Chronic Conditions Research Group
Background
Numeracy is assessed subjectively via confidence in numerical tasks or objectively via computation. Low numeracy is associated with poor communication with providers and disease control in chronic illness. Understanding kidney function requires interpretation of numerical values, yet numeracy is unexplored in end-stage kidney disease (ESKD). We tested whether numeracy associates with increased confidence in communicating with nephrologists and phosphorus control.
Methods
In a cross-sectional study we recorded demographics, clinical data, and validated surveys. Subjective and objective numeracy were measured via the Subjective Numeracy Scale (SNS) and Wide Range Achievement Test (WRAT), and communication via Patient Perceived Efficacy in Patient Physician Interactions. Pearson’s correlations tested associations, and regression models tested associations adjusting for age, sex, race, income, education, cognition, dialysis vintage.
Results
In 150 patients on hemodialysis, subjective and objective numeracy associated with higher income, education, and white race (p<.01) (Table). Subjective numeracy associated with confidence in communication (r=.25,p<.01) even after covariate adjustment (β=.25,p<.05), but not with phosphorus (p=.58). Objective numeracy did not associate with confidence in communication (p=.27) and associated with phosphorus (r=-.18,p<.05) but not in adjusted models.
Conclusion
Poor numeracy is common in vulnerable ESKD patients. Supporting efficacy in numeracy may improve communication with nephrologists, but medication and diet control may be more influenced by computation. Numeracy in ESKD education and counseling may enhance patient engagement.
Numeracy, Demographics, Outcomes with Median, IQR
| SNS r(p) | WRAT r(p) | ||
| SNS s3.5 | 3.4[2.8-4.1] | ||
| WRAT s93 | 89[78-98] | ||
| Age | 52[42-63y] | -.09(.3) | .13(.1) |
| Male | 49% | 3.4[2.8-4.1] (.2) | 92[80-98] (.4) |
| Black | 74% | 3.3[2.6-4.1] (<.05) | 86[76-96] (<.01) |
| Income <29K | 69% | 3.2[2.6-4.2] (<.01) | 84[74-96] (<.01) |
| Education | 12[12-14y] | .32(<.01) | .34(<.01) |
| Literacy(3-15) | 12[10-14] | .37(<.01) | .25(<.01) |
| Communication(22-50) | 42[38-48] | .25(<.01) | .1(.3) |
| Phosphorus -mg/dL | 6[5-7] | .05(.6) | -.18(<.05) |
IQR=interquartile range; s=standardized; y=years; K=,000
Funding
- NIDDK Support