Valuing patients’ dialysis preferences, reported symptoms improves their lived experiences
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Key takeaways:
- Provide decision support to patients when choosing a modality.
- Treat the symptoms most intrusive to a patient’s life.
AUSTIN, Texas — Before receiving the Dr. J Michael Lazarus Distinguished Award, Rajnish Mehrotra, MD, MS, presented ways to improve a patient’s lived experience while using dialysis.
In his lecture, Mehrotra said patients on long-term dialysis have a high burden of disease that includes a high pill burden, a high symptom burden and high dietary restrictions. Compared with in-center hemodialysis, home dialysis or peritoneal dialysis can offer more flexibility and freedom to patients depending on what they value, Mehrotra said. He suggested that allowing patients to decide what dialysis modality they would like to use can improve their lived experiences and help empower them.
“The patient’s voice should be the most important voice in choosing a dialysis modality,” Mehrotra said.
When it comes to symptom burden, he said, the frequency of a symptom should not be the focus for trying to improve the patient’s lived experience. Instead, he said to focus on the most intrusive symptoms, defined by the patient.
Symptoms that go untreated can lead to increased health care utilization and depression, according to evidence cited in the presentation. Additional references showed that patients who experience depression are less likely to adhere to treatment and, therefore, have a worse lived experience.
“What I would encourage you, is that with someone who was not adherent, consider if they are depressed rather than saying ‘You are a bad patient,’” Mehrotra said.
Symptom management for depression can be pharmacologic or nonpharmacologic, Mehrotra said. He referenced a study showing similar improvements in depression among patients on dialysis when using either cognitive behavioral therapy or sertraline treatment. However, making necessary therapy treatments available to patients within the parameters of dialysis care remains a challenge, he said.
“Most patients carry a heavy burden of disease and treatment. At least two considerations can help us improve the lived experience of patients,” Mehrotra concluded. “First is decision support to help select dialysis modality. Then, elicit and manage symptoms guided by patients’ priorities.”
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Mehrotra R. et al. J. Michael Lazarus Distinguished Lecture: Improving the lived experiences of patients undergoing long-term dialysis: Opportunities and challenges. Presented at: National Kidney Foundation Spring Clinical Meetings; April 11-15, 2023; Austin, Texas.
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