Enabling good outcomes in older adults on dialysis: a qualitative study

Abstract

Background: Older patients on dialysis may not have optimal outcomes, particularly with regards to quality of life. Existing research is focused mainly on survival, with limited information about other outcomes. Such information can help in shared decision-making around dialysis initiation; it can also be used to improve outcomes in patients established on dialysis. We used qualitative research methods to explore patient perspectives regarding their experience and outcomes with dialysis. Methods: Semi-structured interviews with participants aged ≥70, receiving dialysis at a regional Australian hospital, were recorded and transcribed. From participants' responses, we identified descriptive themes using a phenomenological approach, with verification by two researchers. Factors affecting outcomes were derived reflexively from these themes. Results: Seventeen interviews were analysed prior to saturation of themes. Participants (12 on haemodialysis, 5 on peritoneal dialysis) had spent an average of 4.3 years on dialysis. There were 11 males and 6 females, with mean age 76.2 years (range 70 to 83). Experiences of dialysis were described across four domains-the self, the body, effects on daily life and the influences of others; yielding themes of (i) responses to loss (of time, autonomy, previous life), (ii) responses to uncertainty (variable symptoms; unpredictable future; dependence on others), (iii) acceptance / adaptation (to life on dialysis; to ageing) and (iv) the role of relationships / support (family, friends and clinicians). Conclusions: Older patients experience the effects of dialysis across multiple domains in their lives. They endure feelings of loss and persistent uncertainty, but may also adapt successfully to their new circumstances, aided by the support they receive from family, health professionals and institutions. From these insights, we have suggested practical measures to improve outcomes in older patients.

Ethical Duties of Nephrologists: When Patients Are Nonadherent to Treatment

“…Whilst there is usually an element of choice to HD nonadherence, it is important to recognise the impact such demanding care can have on a patient and how it can fracture the providerpatient relationship. Patients who do not engage in care the way their nephrologists expect are often viewed in a condescending way [28], which can lead to patient anger [29]. The inherent vulnerability of patients does not necessarily absolve them from wrongdoing [30] but must be appreciated as potentially contributing to adherence issues.…”

The Role of Socioeconomic Status, Family Resilience, and Social Support in Predicting Psychological Resilience Among Chinese Maintenance Hemodialysis Patients

“…Social interaction support showed a positively predictive effect on psychological resilience, possibly due to the fact that individuals who reported greater support received in positive social interactions would have higher levels of self-efficacy ( 43 ) and more resources to cope with stress and the burden of illness ( 44 ). Qualitative studies found that positive social interactions gives hemodialysis patients a sense of meaning in life and hope for the future ( 45 ), as well as positive emotional experiences and self-worth ( 46 ). Thus, nursing interventions focused on promoting positive social interaction support as appropriate and directly or indirectly mobilizing or expanding the social network of the patient may be an effective strategy to improve the psychological resilience of patients.…”

Unmet Needs of Older Adults Receiving In-Center Hemodialysis: A Qualitative Needs Assessment

“…Consistent with a summary of qualitative studies, 21 our participants described developing a need for assistance from others, the emotional impact of life receiving dialysis, and the value of relationship and communication with their providers. In 2 studies specific to older adults receiving dialysis, 22 , 23 support with medications or mobility impairment were identified as key needs. Our study builds on this existing knowledge by incorporating dialysis personnel perspectives.…”