Perceived barriers and facilitators to chronic kidney disease care among patients in Singapore: a qualitative study

Abstract

ObjectiveTo outline the facilitators and barriers to patients’ self-management of predialysis chronic kidney disease (CKD).DesignQualitative.SettingThree polyclinics in a public primary care institution in Singapore.Participants20 patients entered and completed the study. Inclusion criteria were: (1) English speaking, (2) aged 40 years and above, (3) identified by clinical coding as ‘DM (diabetes mellitus) nephropathy-overt’ and ‘DM nephropathy-incipient’, by their physicians in the polyclinic, with an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 (based on electronic health records) and (4) aware of their CKD illness. Exclusion criteria were: (1) receiving dialysis or had received a kidney transplant, (2) suffered from any visual, auditory or cognitive impairment which could hinder their ability to participate in the study or (3) pregnant.ResultsWe found that the major barriers to CKD management were a lack of knowledge and awareness of CKD, a passive attitude toward self-management and insufficient patient-physician communication. Major facilitators included patient trust and satisfaction with the physician and family support. Many patients reported that there was an overload of information and too little guidance on how to manage their condition, especially regarding dietary recommendations.ConclusionWe identified several barriers and facilitators to the management of predialysis CKD among patients. A multi-pronged approach for raising CKD awareness is required: improving patient-physician communication, implementing CKD workshops and home-visits and disseminating accurate online information about CKD. Strategies should also focus on increasing patient engagement and optimising family support by involving family members in patients’ care. Furthermore, clear dietary recommendations and patient-specific advice are needed to empower patients to manage their own condition.

Computer-Assisted Evaluation of Patient Information Leaflets (PILs) for Chronic Kidney Disease Compared with Marketed PILs

“…It was surprising to realize that almost one-third of the PILs in our sample did not specify how potential volunteers may learn about CKD. When developing PILs for chronic diseases, it is critical to focus on the [15,16]. To make PILs more valuable for prospective participants, have participant representatives assist to develop them and emphasize how patient feedback will or has been included in research data sharing.…”

Factors Affecting Diet-Related Quality of Life Among Hemodialysis Patients According to Age-group

“…This is likely because younger hemodialysis patients depend on their parents or family for treatment or dietary management. They thus experience greater depression, decreased confidence, and more negative attitudes, which create barriers to self-management and lead to reduced performance of fluid control behavior (Gebrie & Ford, 2019; Hwang et al, 2020; Kerklaan et al, 2020). Additionally, family support and emotional states were better in the 60+ age group than in the younger cohort.…”

Healthcare professionals’ perspectives on facilitators of and barriers to CKD management in primary care: a qualitative study in Singapore clinics

“…Lack of awareness and knowledge on their chronic condition often limits individuals to engage in desired self-management behaviours as recommended by physicians. Multipronged approach to patient education, and increasing patient engagement have been recommended as useful strategies for improving self-management of CKD [ 11 ].…”

“…Existing literature suggests impediments to CKD management in primary care exists at multiple levels [ 10 ]. Patient-reported challenges and perceptions on CKD management are well documented [ 11 ]. However, there is limited understanding on the challenges and opportunities to enhance CKD management from perspectives of HCPs involved in direct care of patients with CKD.…”