Survey: Patient-related barriers exist to timely preparation for dialysis
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A published study identified six primary themes that may partially explain why patients delay in preparing for dialysis initiation by way of access creation.
“Systematic reviews of studies based on mainly established [hemodialysis] HD patients indicate that concerns related to vascular access and treatment burden are dominant treatment stressors,” Konstadina Griva, PhD, of Lee Kong Chian School of Medicine in Singapore, and colleagues wrote. “However, the accounts of patients already on [renal replacement therapy] RRT may be subject to recall bias making their views of limited value. Reviews of medical records are informative of system/provider factors but do not document patient-related barriers or at best rely on indirectly inferred patient information. There remains limited work on [chronic kidney disease] CKD patients not yet on dialysis but at the point of delaying dialysis preparation.”
Further, the researchers added there is a lack of information on the perspectives of family members and kidney health care providers, “who are potential powerful influences on patients’ decisions regarding starting HD with permanent access.”
To more fully examine the reasons behind delays in dialysis preparation, researchers conducted interviews with patients with stage 4 CKD, patients newly on hemodialysis with and without permanent access, family members and kidney health care providers.
They found patients were likely not to move toward access creation due to a lack of symptoms, fear of dialysis and practical concerns (including pain, cost and lifestyle disruptions), risks of access creation (including threat of operation), preference for alternatives, social influences (such as family involvement or experiences of others) and health care provider interactions (including mistrust or lack of clarity of information).
Regarding pre-dialysis education, the researchers noted that the interviews revealed differences in the priorities of patients and their families vs. health care providers. For instance, while patients and their families wanted to explore “the practical aspects and the subjective experience of life on dialysis,” providers tended to center the education on “biomedical-centric information about dialysis modalities” while paying little attention to psychological impact.
The researchers wrote, “Earlier initiation of pre-dialysis education to allow progressive exposure to ESKD information ahead of deteriorating kidney health alongside discussion of values and preferences or concerns may help to ease psychological discomfort, as suggested by research on cognitive behavior therapy and exposure-based approaches. Given the dominance of financial concerns among patients and families, advanced planning related to financial matters may be a good starting point for such discussions.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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