Patient perspectives of coping with automated peritoneal dialysis

Abstract

Background: Patients receiving peritoneal dialysis (PD) experience poor quality of life, depression, anxiety and lifestyle changes. Insights into how patients adjust to and cope with PD from a psychological perspective will aid care. Methods: Participants were recruited purposively through the Central Northern Adelaide Renal and Transplantation Service in South Australia. Ten patients receiving automated PD (APD) (5 females and 5 males) aged 31 to 77 years (M = 59.3) participated in a semi-structured interview. Interview transcripts were analysed thematically through inductive and deductive methods. Results: Five main themes representing participants’ experiences and perspectives of adjusting to and coping with APD were identified: (1) Resigned Acceptance, (2) A Bridge to Transplant, (3) Navigating Emotions at Milestones and Transitions, (4) Professional Support (Sub-themes: Psychological Support and Education and Information Delivery and (5) Social Enablers (Sub-theme: Hidden from View and Hiding Illness). Conclusions: Patients employ cognitive, emotional and behavioural strategies and rely strongly on social supports to cope with APD. PD at home aids preservation of pre-illness identity, however, also results in feelings of isolation and being misunderstood. Psychological distress and poor coping may be heightened at key disease milestones and transition periods when professional psychological support should be offered. We provide suggestions to address patients’ psychosocial needs and coping in treatment decision-making and dialysis care.

Patient perspectives on peritoneal dialysis (PD) and the PD catheter: Strategies and Solutions

“…14 Another recent qualitative study suggests that professional psychological support may be helpful, especially during key disease milestones such as being diagnosed as 'end-stage' and following dialysis initiation. 19 In these and other studies, patient re-framing of their situation associated with coping ability.…”

“…Drain sluggishness and pain on the cycler, with alarms and sleep disturbances, have been previously reported. 19,23 Even so, clinically significant drain issues may be under appreciated. 24 In this sample, drain difficulties and pain were prevalent and problematic.…”

“…An iterative inductive/deductive approach was used. 13 For deduction, a hierarchical coding system was developed using the interview guide, clinical experience, review of the literature [14][15][16][17][18][19] , preliminary review of transcripts and clinical experience. Major categories included (1) home environment, (2) emotional response, (3) physical day-today routine, (4) enablers, (5) barriers, (6) support, (7) complications, (8) quality of life, (9) prior modality, (10) coping physical, (11) coping emotional, (12) surprising answers, (13) COVID-19, (14) self-perception, (15) causal attributions, (16) control, (17) problem solving and (18) strategy source.…”

Effect of Patient-Empowerment Interaction Model on Self-Management Ability of Peritoneal Dialysis Patients: A Randomized Controlled Trial

“…Previous studies showed that PD at home aided preservation of pre-illness identity, but resulted in the feelings of isolation and being misunderstood. 27 After intervention such as telemedicine, patients felt a greater sense of control, and achieved positive attitude. 28 In our study, the empowerment model of PBL health education could be another effective intervention to improve anxiety among PD patients.…”

Patient commentary on ‘Patient Perspectives of Coping with Automated Peritoneal Dialysis’

“…Identified by Duncanson et al’s (2021) 1 study ‘Patient Perspectives of Coping with Automated Peritoneal Dialysis’, the themes of the psychosocial challenges and coping responses among patients receiving automated peritoneal dialysis (APD) are relevant and valid. One of the themes identified in this interview study was Resigned Acceptance of kidney failure and PD, which helped patients cope with challenges and consequently they were adherent to treatment.…”