Patient Perspectives on the Meaning and Impact of Fatigue in Hemodialysis: A Systematic Review and Thematic Analysis of Qualitative Studies

Jacobson, J. E.; Ju, Angela; Baumgart, Amanda; Unruh, Mark; O’Donoghue, Dónal; Obrador, Gregorio T.; Craig, Jonathan C.; Dapueto, Juan M.; Dew, Mary Amanda; Germain, Michael J.; Fluck, Richard; Davison, Sara N.; Jassal, Sarbjit V.; Manera, Karine; Smith, Alice C.; Tong, Allison

doi:10.1053/j.ajkd.2019.01.034

Cited by 85 publications

(82 citation statements)

References 71 publications

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“…With the finding that PDF intensity, duration and frequency were significantly correlated with each other further strengthens this concept. This is well in accordance with the findings of the study of Jacobson et al (2019 , p. 181) that “some patients felt that each haemodialyses session depleted them of all their energy and strength, and that they felt worn out or exhausted by the treatment, and that some felt drained as soon as they unhook and needed to return home quickly where they could collapse”. It is also understandable why patients on chronic haemodialysis rate fatigue to be a critical and important outcome even above survival, disability, phosphorus, pain, anaemia and target weight (Evangelidis et al 2017; Tong et al 2017).…”

Section: Discussionsupporting

confidence: 91%

Intensity, Duration, and Frequency of Post‐Dialysis Fatigue in Patients on Chronic Haemodialysis

Bossola

Stasio

Monteburini³

et al. 2020

Journal of Renal Care

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Bossola M., Di Stasio E., Monteburini T., et al. (2020). Intensity, duration, and frequency of post-dialysis fatigue in patients on chronic haemodialysis. Journal of Renal Care 46(2), 115-123. S U M M A R YBackground: Although frequent and debilitating, little is known about the characteristics of post-dialysis fatigue (PDF). Objective: To characterise the intensity, duration and frequency of PDF and the associated variables in patients on chronic haemodialyses. Design: Prospective, observational and multicenter study. Patients: We studied 271 patients. Measurements: Patients were considered to be suffering from PDF if they spontaneously offered this complaint when asked the open-ended question: "Do you feel fatigued after dialysis? Then, each patient was invited to rate the intensity, duration and frequency of PDF from 1 to 5. Results: One hundred sixty-four patients (60.5%) had PDF. The median [95% confidence interval (CI)] scores of PDF intensity, duration and frequency were 3 (3-4), 3 (3-4) and 4 (4-4), respectively. The median (95% CI) of the sum of the scores (Sum Score) of PDF intensity, duration and frequency was 11 (10-12). Seventy four patients had a Sum Score ≥ 12. Using multiple regression analysis, PDF intensity was associated with dialytic age and ultrafiltration rate (UFR), PDF duration with dialytic age, while PDF fatigue frequency was associated with height. The Sum Score was associated with dialytic age and recovery time and negatively associated with daily activity, height and UFR (ml/kg/h). Conclusion: The intensity, duration and frequency of PDF are high in a large percentage of patients, suggesting that PDF is an intense event in terms of quantity and quality. Understanding the relationship between the variables associated with PDF and its intensity, duration and frequency may help better understand the underlying mechanisms of this burdensome condition. K E Y W O R D S Haemodialyses⦁ Fatigue ⦁ Post-dialysis ⦁ Recovery time ⦁ Ultrafiltration rate

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Section: Discussionsupporting

confidence: 91%

Intensity, Duration, and Frequency of Post‐Dialysis Fatigue in Patients on Chronic Haemodialysis

Bossola

Stasio

Monteburini³

et al. 2020

Journal of Renal Care

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“…[ 36–38 ] Additionally, subjects shared aspects of their individual experience with haemodialysis care and its difficulties, like excessive fatigue, strict diet, giving up on vacation plans, and more. [ 39,40 ] Perhaps the unexpected theme of desiring improvement to health care for all is intimately linked to this reality.…”

Section: Discussionmentioning

confidence: 99%

Issues with deprescribing in haemodialysis: a qualitative study of patient and provider experiences

Bondurant-David

Dang

Levy

et al. 2020

International Journal of Pharmacy Practice

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Rationale, aims and objectives Patients undergoing haemodialysis receive on average 10–17 medications, which increase the risk of falls, adverse drug reactions and hospitalizations. Supervised discontinuation of potentially inappropriate medications may lower these risks. Although many calls have been made for deprescribing in the haemodialysis setting, little is known about how patients and providers in this setting experience it. The aim of this study is to explore patient and provider experiences and perceptions of one of the rare deprescribing intervention in haemodialysis. Methods Ten semi‐structured interviews were held with patients, and a focus group was done with dialysis clinic team members at a Montreal area health network’s haemodialysis clinic after the implementation of a standardized deprescribing intervention using the patient‐as‐partner approach. The interviews and focus group were recorded, and verbatims were coded to determine emerging themes. Grounded theory was used for interview guide design and data analysis. Results The three emerging themes were (1) ambivalence towards medication creating a favourable context for deprescribing, (2) the empowering elements of the deprescribing process and (3) the uncertain future of deprescribing in the clinics even though the intervention was considered successful. Conclusion Haemodialysis patients and providers viewed deprescribing favourably, believed the intervention was valuable, and offered suggestions for long term implementation while expressing concerns about feasibility. Notwithstanding the underlying uncertainties, a structured and integrated approach in routine practice involving all members of the care team may facilitate the continuity of deprescribing as an intervention in the setting of a haemodialysis clinic.

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“…Similarly, while exercise training has evidence to support its efficacy [31,32], many dialysis patients report feasibility or other barriers to participating in exercise [9,33]. Recent studies have reiterated the profound negative impact of fatigue on patient well-being and life participation, highlighting the need to investigate alternative approaches that can assist dialysis patients with day-to-day fatigue management [3,5]. The energy management education approach is advantageous because it is not specific to any one fatigue etiology, but can be used with anyone who experiences physical fatigue.…”

Section: Discussionmentioning

confidence: 99%

“…Defined as an "unusual, abnormal or excessive wholebody tiredness, disproportionate to or unrelated to activity or exertion"[2,p.285], fatigue and its negative impact on life participation (ie. the ability to participate in valued day-to-day activities) have been identified as high-priority issues by people on chronic dialysis [3][4][5]. The purported factors contributing to fatigue in renal disease are multifactorial, including anemia, chronic inflammation, malnutrition, uremia, depression, sleep quality, and physical inactivity [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Exploring an Energy Management Approach to Improve Fatigue and Life Participation in Adults on Chronic Dialysis

Farragher

Polatajko

McEwen

et al. 2019

Preprint

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Background Fatigue and its negative impact on life participation are top research priorities of people on chronic dialysis therapy. Energy management education is a fatigue management approach that teaches people to use practical strategies (e.g. prioritizing, using efficient body postures, organizing home environments) to manage their energy expenditure during everyday life. The study objective was to explore if energy management education is associated with improvements in fatigue and life participation in adults on chronic dialysis. Methods This study consisted of five single-case, interrupted time-series AB studies, and follow-up qualitative interviews. Participants on chronic dialysis therapy at an academic hospital in Toronto, Canada were purposively selected to represent diversity in age, gender and modality. All 5 participants underwent “The PEP Program”, a personalized, web-supported energy management education (EME) program designed to meet the needs of people on dialysis. During the program, participants complete two brief web modules about energy management, and then use energy management principles and a problem-solving framework to work on 3 life participation goals during sessions with a trained program administrator. Fatigue and life participation were measured weekly using short questionnaires during the baseline and intervention periods, and additional validated questionnaires (the Fatigue Impact Scale, SF36 Vitality Scale, & Canadian Occupational Performance Measure) were administered pre- and post-intervention. Data were analyzed using visual analysis and the Tau-U statistic for the weekly time-series data, and thematic analysis for the qualitative interviews. Results Three of five participants displayed a consistently positive response to the PEP program across multiple measures of fatigue and life participation. Tau-U effect size estimates ranged from small to moderate, according to the time-series data. All five participants expressed that the program had benefitted them in qualitative follow-up interviews, with the most common reported benefit being that the program made day-to-day activities easier. The format of the program was also said to be feasible and convenient. Conclusions The PEP program has potential to improve fatigue-related outcomes in people on chronic dialysis. Larger, controlled studies of the program are now warranted.

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Patient Perspectives on the Meaning and Impact of Fatigue in Hemodialysis: A Systematic Review and Thematic Analysis of Qualitative Studies

Cited by 85 publications

References 71 publications

Intensity, Duration, and Frequency of Post‐Dialysis Fatigue in Patients on Chronic Haemodialysis

Intensity, Duration, and Frequency of Post‐Dialysis Fatigue in Patients on Chronic Haemodialysis

Issues with deprescribing in haemodialysis: a qualitative study of patient and provider experiences

Exploring an Energy Management Approach to Improve Fatigue and Life Participation in Adults on Chronic Dialysis

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