Dialysis Decision Making, Dialysis Experiences, and Illness Perceptions: A Qualitative Study of Pakistani Patients Receiving Maintenance Hemodialysis

Dialysis Decision Making and the Patient Experience: Lessons From Pakistan

“…In this issue of Kidney Medicine , Malik and colleagues 8 investigate the kidney care experience for Pakistani patients receiving dialysis. The authors utilized phenomenological qualitative research methods to investigate the dialysis experience of 20 individuals receiving in-center hemodialysis in 2 urban outpatient dialysis units in Pakistan.…”

“…6 Malik and colleagues’ findings illustrate the importance of aligning spirituality, religiosity, and traditional medicine in dialysis decision making in Pakistan and perhaps more broadly. 8 Community-based and clinical interventions in CKD care may consider including factors such as spirituality, religiosity, and traditional medicine into health promotion efforts.…”

“… 14 Further, another study found many Pakistani patients believed their kidneys would recover when dialysis was initiated. 6 Malik and colleagues 8 build on the drivers behind many of the findings in preceding survey studies; patients felt doctors did not spend enough time explaining the disease, course of therapy, and treatment alternatives. In addition, they felt the lack of information influenced their distrust of physicians.…”

“…Higher levels of illness intrusiveness are associated with lower quality of life for Pakistani people receiving dialysis in many areas, including physical health, psychological health, social relationships, and environment. 7 Although quality of life was not addressed by Malik and colleagues, 8 it is possible that inadequate dialysis treatment compounds quality of life, affecting patients’ dissatisfaction with their treatment plan.…”

“…Affordability of dialysis is a major concern in many low- and middle-income countries where out of pocket treatment costs are high. 21 The study by Malik and colleagues 8 included individuals paying out of pocket for dialysis as well as individuals receiving charitable (free) dialysis. Among individuals receiving charitable dialysis, there were also financial constraints, often related to cost of transportation and income loss due to inability to work because of symptom burden and constraints on time from dialysis treatments.…”