Travel arrangements in chronic hemodialysis patients: A qualitative study

Abstract

Introduction For patients on renal replacement therapy (RRT), “travel” and “independence” are rated as 2 of the top 5 factors that inform their choice of treatment modality. While home dialysis modalities offer patients a high degree of independence, the most common RRT in the United States is in‐center hemodialysis (IHD). The limits imposed by IHD treatment can present a variety of challenges for patients who wish to travel. This study explored how IHD patients managed their travel and the role of dialysis social workers in executing travel arrangements for patients. Methods We performed a qualitative descriptive investigation using semi‐structured interviews with adults receiving IHD (n = 16) and renal social workers (n = 8) from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin. Data were analyzed using a constant comparative method. Findings Three themes emerged from the interviews: travel process, travel‐related barriers, and travel‐related facilitators. The travel process entailed transient dialysis unit challenges and the need for multiple preparations and precautions. Barriers included comorbidities and not having a relationship with transient dialysis unit staff. Facilitators focused on the importance of travel and staff professionalism at transient dialysis units. Overall, there was lack of uniform protocols to guide the travel process at the patient and the dialysis unit levels. Discussion This study identified multiple perspectives regarding travel arrangements in chronic IHD patients. There is limited research on travel issues for IHD patients and this investigation is among the first to articulate barriers and facilitators associated with travel from the perspective of patients and social workers. Supporting travel for IHD patients can increase their sense of autonomy and provide opportunities to improve their quality of life.

What are the qualitative experiences of people affected by kidney failure receiving haemodialysis?

“…The experience of the sense of self impacted employment and their sense of positional role within the family unit (Aghakhani et al, 2014; Liu et al, 2022). While some people affected by kidney failure receiving HD gradually adjusted over time with acceptance (Wongboonsin et al, 2021), some continued to grapple with HD and used avoidance coping strategies.…”

“…The dependence on HD for life encompassed the inflexible nature of treatment schedules and dietary routines, which meant that patients were unable to be spontaneous any longer. The continual dependence on treatment also meant that it was difficult for people receiving HD to take holidays (Senteio & Ackerman, 2022; Wongboonsin et al, 2021). Some were dependent on renal centre transport to and from the hospital to receive HD.…”

“…When a therapeutic and positive relationship was established between patient and health professional, the patient reported feeling well cared for and involved in the decision‐making about their treatment (Calvey & Mee, 2011). Other patients felt rushed during consultations with their medical team with little time to consider the information shared with them (Salter et al, 2015; Wongboonsin et al, 2021) and this was viewed as suboptimal dialysis care (Andersen‐Hollekim et al, 2020; Shahgholian & Yousefi, 2018).…”

“…Other patients felt rushed during consultations with their medical team with little time to consider the information shared with them (Salter et al, 2015;Wongboonsin et al, 2021) and this was viewed as Promoting physical activity while being hooked up to HD was regarded as important for future models of service delivery.…”

Travel arrangements in hemodialysis patients during the COVID‐19 pandemic including London‐style “black cabs” for transfer to a designated isolation unit

“…To the Editor: In the recently published study, Wongboonsin et al 1 highlight the importance of travel arrangements in patients receiving intermittent hemodialysis (ICHD) requiring transport to the dialysis facilities three times weekly to receive life-sustaining treatment. The COVID-19 pandemic has posed immense challenges on ICHD patient transportation 2 requiring a rapid and major reconfiguration of travel arrangements in order to ensure treatment is delivered timely and cross-infection risk from COVID-19 is minimized.…”