Effective Communication and Counseling Approaches

The prevalence of chronic kidney disease (CKD) has been rising over the past several decades and currently afflicts approximately 37 million American adults [1]. It was estimated in 2016 that 661,000 adults in the United States had kidney failure, with 468,000 receiving dialysis and 193,000 living with a functioning kidney transplant [2]. In addition to physical detriment, those with CKD also experience psychosocial detriments that influence how they view the dietary restrictions of the renal diet and their personal motivation aimed at self-care efforts [3, 4–5]. Complicating life further for people with CKD are the psychological and social burdens that ripple toward the patient’s expanded circle of family and friends, thereby creating a negative impact on an even greater number of individuals. These burdens undoubtedly influence the high prevalence of depression seen in patients with CKD, which is reported to be between 20% and 30% of patients [6, 7]. Research supports that the transition from CKD to end-stage renal disease (ESRD) may be slowed through dietary and lifestyle choices. In addition, individuals with ESRD may improve their longevity and quality of life by following an appropriate dietary protocol [8, 9, 10–11]. However, adherence to dietary restrictions in this population is low [12]. Researchers performed qualitative interviews with 16 patients receiving maintenance hemodialysis that led to the development and distribution of a survey to 156 similar patients. The results of this qualitative and quantitative study revealed that very few patients perceived any immediate positive effects from following their dietary restrictions. The researchers believe this may be one major reason for poor dietary adherence [4]. Clearly, there is a need for dietitians to guide patients with CKD to a better understanding about the influence of appropriate diet and lifestyle choices, as well as a need to confer a sense of empowerment to the patient with CKD. It is essential that dietitians use effective strategies during nutrition counseling sessions to improve outcomes. Nutrition counseling approaches in the past have often involved education-based, directive style expert-centered guidance. More recently, patient-centered counseling approaches that focus on empowerment and shared decision-making have emerged and have shown improved patient outcomes [4, 13, 14]. The recommendation to use collaborative management in counseling patients with chronic illnesses has been suggested for over a decade [15]. However, implementing the theories of patient-centered, jointly owned planning in nutrition counseling has taken time to develop. Currently, dietitians have a communication and counseling toolbox filled with strategies to draw upon that serve to promote behavior change, ultimately improving patient health outcomes. The use of the transtheoretical model (TTM) in guiding dietitians in identifying the stage of change each patient is experiencing has become a practical tool to use during the counseling process. Cognitive behavioral therapy (CBT) and motivational interviewing (MI) have also emerged as efficacious models to employ in promoting change in patient’s food and lifestyle behaviors [4, 16, 17–18]. This chapter will review techniques and strategies inherent in several models that can be used by dietitians while counseling patients with CKD to achieve increased dietary adherence, ultimately resulting in improved health outcomes, quality of life, and longevity.