Is 'patient activation measure' relevant for adults on dialysis?

The Patient Activation Measure (PAM) is a standardized instrument that assesses an individual's knowledge, ability, skills, and confidence in self-managing chronic medical conditions. A study published in JASN examined whether PAM is a meaningful metric for adults with kidney failure who are on long-term dialysis. These patients are actively involved in multiple domains of their care, such as keeping track of frequent treatments, following specified diets, and taking multiple medications.

The study included 175 patients being treated with in-center hemodialysis between August 2020 and January 2021 at 3 sites (2 in New York City and 1 in Seattle). There was no significant relationship between PAM scores and missed dialysis sessions or weight gain between dialysis sessions. Investigators found a strong relationship between lower PAM scores and lower levels of health literacy and higher levels of depression and anxiety, however.

"Living with kidney failure is difficult and requires a lot of effort to keep up with all of the necessary treatments, doctor's visits, and medications. Finding ways of supporting motivated patients and helping to develop strategies to engage others is essential for the patients' overall health," said lead author Daniel Cukor, Ph.D., of The Rogosin Institute, in New York. "The extent to which the PAM describes a patient with kidney failure's level of engagement is unclear, as the measurement may be picking up on other issues known to interfere with engaged care, such as low health literacy and high levels of depression or anxiety, which are very common comorbidities in this population. The fact that the PAM was highly associated with these known variables, but not measures of dialysis attendance or dietary compliance, raises questions about its utility."