Study: Keep dietary advice simple for stone patients

When it comes to counseling patients on kidney stone prevention, less may be more, suggests a study presented at the National Kidney Foundation's spring clinical meetings in Las Vegas.

"You have to prioritize your recommendations," said study co-author R. Allan Jhagroo, MD, of the University of Wisconsin, Madison. "Too much can be overwhelming."

To investigate how well patients recalled recommendations made to them about diet, Dr. Jhagroo and his colleagues surveyed 17 men and women who had received nutrition counseling during the past 4 months.

The patients had been given an average of three recommendations each, along with written handouts describing their nutrition plan. The most common recommendations included eating at least five servings of fruits and vegetables a day, increasing fluid intake by a specific amount, and increasing or changing the distribution of calcium intake throughout the day.

About one-third (35%) of the patients had perfect recall of all the recommendations they were given. Among patients given three or more recommendations, 28% remembered all of them. In contrast, among patients given only one or two recommendations, 50% remembered everything they were told. While 24% of the patients said they had difficulty following the recommendations, 87% said they found the recommendations "acceptable," and all said they would be willing to keep trying to follow them.

Dietary recommendations must be made on a patient-by-patient basis, depending on several factors including the type of stones a patient tends to form, Dr. Jhagroo noted.

"If you give one or two recommendations, you're more likely to have people remembering what you said and following what they were asked to do," he said.

"Evaluating how to best educate and motivate people to make lifestyle changes and maintain compliance with prescribed medical therapies is critical to preventing disease and improving health outcomes," said Beth Piraino, MD, of the National Kidney Foundation.

"How clinicians provide the instructions to their patients is important to adherence with prescribed treatment such as diet regimen to reduce kidney stone formation," Dr. Piraino added. "Patient understanding is improved when the information is provided in a simple, digestible manner. Clinicians need to develop methods to provide this information incrementally to allow better comprehension and adherence, rather than trying to provide all of the information in a single office visit."

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