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Provider Awareness, Systematic Referral Processes May Help Peer Support Uptake in CKD


Peer support can be a helpful facet of chronic kidney disease (CKD) self-management, but inconsistent provider awareness and referral practices are barriers to uptake at Canadian clinics.

Although multidisciplinary chronic kidney disease (CKD) care includes peer support programs at some institutions, a recent study published in BMC Nephrology suggests health care provider awareness of and availability of peer support programs vary at Canadian CKD clinics.

Lifestyle choices can significantly affect disease progression in CKD, which is estimated to affect 13% of the global population, and peer support can prove useful for patients with CKD looking for information, emotional support, and self-management advice. Peer support can also help patients feel validated in their individual CKD experiences.

“Despite its benefits, the role of peer support in the comprehensive care of persons with non–dialysis-dependent CKD remains unestablished,” the study authors wrote. “Opportunities for informal peer connection in non–dialysis-dependent CKD are uncommon, and uptake of formal peer support programs has traditionally been low, with variability in how it is promoted and offered.”

Previous research has shown variability in awareness and promotion of peer support programs, and the current study aimed to provide insight on provider awareness and experiences with peer support programs within multidisciplinary CKD clinics.

An online survey sent out to clinics across Canadian provinces received 113 provider responses from 49 locations. Of the respondents, 84% provided care to patients with non–dialysis-dependent CKD and 48% were nurses within multidisciplinary care teams at CKD clinics.

Overall, 66% of respondents were aware of formal CKD peer support programs for patients who are not dependent on dialysis. Of those providers, 81% were aware of the Kidney Foundation of Canada’s “Kidney Connect” program, which has been a main patient resource for telephone-based peer support for almost a decade. In the group aware of formal programs, 79% reported referring patients to a peer support program and 19% of providers offered in-clinic peer support programs. Informal peer support encounters at the clinic, such as during educational sessions, were noted by 43% of respondents.

Respondents’ roles and regions of Canada were associated with awareness of peer support programs, but years of experience did not affect awareness levels. Social workers and nephrologists were typically aware, and about half of nurses and two-thirds of other health professionals were aware of such programs. Nurses and social workers most often referred patients to programs, while it was less common for nephrologists or other allied health professionals to refer patients.

Eight social workers, 5 nurses, 3 managers, and 2 nephrologists did semi-structured interviews with researchers that provided insight into the ways peer support groups are offered and integrated at clinics. Most providers reported a lack of availability of in-house programs, meaning they relied on external programs that patients usually found independent of any referral. There was also variation in referral practices between teams. A lack of culturally and linguistically diverse programs—including programs to connect patients living in remote areas—was also a concern for providers. Smaller clinics also reported feeling unable to reach a wider range of patients with CKD.

Overall, main barriers to peer support group facilitation and referral were inconsistent awareness among providers; challenges with virtual technology considering the COVID-19 pandemic, which derailed in-person programs for a period; and provider workloads. Ways to improve peer support uptake include systematic referral approaches, including assigning the role among team members; staff education about peer support groups; and facilitating close relationships between clinics and external organizations that offer peer support groups.

These findings show less awareness around peer support groups than previous research has shown overall, but the providers surveyed recognized the importance of promoting programs to patients with CKD. Targeting providers who were less aware of peer support groups in this study, such as nurses and other allied health professionals, could help improve the referral rates at multidisciplinary clinics.

“Some CKD clinics may have the resources and connections to implement their own in-house peer support program, whereas others may be better suited to external peer support program referral or integration of informal peer support into clinic-based educational programs,” the study authors wrote. Using any existing program structures and learning from other programs can also assist with forming effective strategies for peer support uptake.

Although the study did not include every CKD clinic in each region, the data suggest more work is needed to establish systematic approaches and evaluate the effectiveness of current systematic approaches for integrating peer support programs into multidisciplinary CKD care.


Love S, Harrison TG, Fox DE, et al. Healthcare provider perspectives on integrating peer support in non-dialysis-dependent chronic kidney disease care: a mixed methods study. BMC Nephrol. Published online April 18, 2022. doi:10.1186/s12882-022-02776-w

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