Page 37 - Exploring the Potential of Self-Monitoring Kidney Function After Transplantation - Céline van Lint

Patient experiences with self-monitoring after transplantation 35
demanding than interpreting a single measurement value, as trend monitoring requires a careful consideration of the combination of several measurements.
Secondly, satisfaction about self-monitoring was related to patients’ perceived support from their physicians to be autonomous. This is in line with self-determination theory41, which emphasizes the need of autonomy supportive social contexts. It also emphasizes that patients do consider self- monitoring as a care system in which their physicians keep playing an important role. Indeed, several studies show that patients consider self-monitoring as a less attractive option if this automatically implies a loss of human interaction with the clinical staff.19;42
Although patients were satisfied with the general amount of autonomy support from their physicians, interview data revealed that several physicians paid little attention to the self-measured creatinine data. Previous studies have also shown that physicians may be somewhat hesitant towards patient self-monitoring.43;44 It has been suggested that physicians consider it difficult to determine whether patients are capable of self-monitoring and interpreting the measurements45;46, are afraid that self- monitoring will lead to a loss of control over therapy, and think that allowing patients to self-monitor will be more time-consuming.45;47;48 However, in the current study physicians did pay attention to self- measured blood pressures. The difference in attention for creatinine and blood pressure measurements might be due to a relatively low level of trust in the accuracy of the creatinine device. Although they were also informed on the suitability of the device for monitoring creatinine trends, physicians expressed doubts about the accuracy of the meter due to a variation in successive measurements. The greater familiarity with home-based blood pressure monitoring might have also played a role. The positive effects of self-monitoring blood pressure on therapy outcomes have been clearly demonstrated27;49, whereas for self-monitoring creatinine this has yet to be established. Thirdly, patients were more satisfied if they had a high self-efficacy regarding their own monitoring skills. The importance of self-efficacy for experienced satisfaction has been shown before20;21, suggesting that thoroughly instructing and supporting patients are important prerequisites for successful and satisfactory self-monitoring.
Our data did not support the suggestion that self-monitoring bodily symptoms could cause (unnecessary) worry and doubts13;26, or would be more or less beneficial for worried patients. Finally, to enhance a safe implementation of self-monitoring in which self-measured values are an important source of information, patients should adhere to the self-monitoring protocol. Non- adherence to the protocol may leave serious complications unnoticed, which could ultimately lead to permanent loss of kidney function. Protocol adherence in the current study was generally good with the majority of patients measuring more often than requested. Considering that fear of rejection is common in patients after a (recent) transplantation7-10, it is tempting to assume that conducting extra
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