End-stage renal disease is not yours, is not mine, is OURS: Exploring couples lived experiences through dyadic interviews

A life-changing process when living with chronic kidney disease: A qualitative study

BACKGROUND

Patients with chronic kidney disease and their family members experience a number of lifestyle changes caused by the illness. The value of advance care planning includes understanding health status and options for future care, communication between close family members, and identification of wishes and preferences for care and treatment in relation to family and everyday life.

OBJECTIVE

Explore how patients with chronic kidney disease and their families experience everyday life and how they experience having to make choices about treatment.

DESIGN

An explorative study using a qualitative method with a phenomenological-hermeneutic approach.

PARTICIPANTS

Twelve patients with chronic kidney disease without kidney replacement therapy who were considering their treatment options and eight family members.

APPROACH

Individual semistructured interviews with a narrative approach were conducted between August 2021 and March 2022. The data were analysed using Ricoeur's interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion.

FINDINGS

One main theme was generated: Family dynamics in a life-changing process. From this, three subthemes were derived: Living in an ordinary life placed in a waiting position, The dilemma of readiness to share and Feelings of being left alone.

CONCLUSION

There are changes in family roles and in identity and a desire to maintain the known and ordinary life. Living with chronic kidney disease as a part of daily life is managed differently in the family, which can lead to feelings such as sadness, frustration and loss of shared life and resilience.

The Lived Experience of Middle-Aged Saudi Patients With End-Stage Chronic Renal Disease on Hemodialysis Treatment

INTRODUCTION

More than 20,000 patients with chronic renal disease are receiving hemodialysis treatment in Saudi Arabia. Approximately, 57.4% of nurses in Saudi are expatriates. However, these nurses may not have sufficient cultural knowledge, which may affect perception of nursing care. Our purpose was to understand the lived experiences of middle-aged Saudi Arabian hemodialysis patients.

METHOD

This qualitative phenomenological study was conducted in Saudi Arabia in 2021. Data were analyzed using axial coding.

RESULTS

Eleven patients aged 32 to 60 years participated. Two themes and three subthemes were identified: (a) hemodialysis's negative consequences (travel restriction, social isolation, and low responsibilities toward families) and (b) level of support (family support, nurses' support, and governmental support).

DISCUSSION

Hemodialysis patients find travel and social engagement difficult. Furthermore, they cannot fully meet their family responsibilities due to fatigue and long hemodialysis hours. Health care providers should consider integrating these findings to deliver optimal holistic care.

Caring for parents with end-stage renal disease: What do adult children face and how do they cope?

AIM

This study aimed to explore the stressors and coping strategies of adult children who care for their parents with end-stage renal disease (ESRD) undergoing in-centre haemodialysis.

BACKGROUND

Given the growing number of older patients with ESRD, adult children are increasingly providing more care and assistance to their parents with this condition. However, little is still known about the experiences of caring for a parent undergoing haemodialysis.

DESIGN

A qualitative exploratory study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

METHODS

Semi-structured face-to-face interviews with nineteen adult children (44.9 ± 11.7 years old) were carried out. Data were transcribed verbatim and subjected to thematic analysis.

RESULTS

Four stressors (managing disease and treatment-related requirements, patients' reaction to treatment, lack of support from family members, and additional challenges to personal and family life) and five coping strategies (active coping and planning, seeking social support for emotional use, accepting the situation as it is, venting emotions, and maintaining interests outside caring) were identified.

CONCLUSION

Caring for a parent undergoing haemodialysis is an experience with several challenges, marked by educational needs, emotional distress, lack of support from close relatives and the need to manage multiple responsibilities.

RELEVANCE TO CLINICAL PRACTICE

Findings highlight the importance of developing interdisciplinary educational and supportive interventions to support this group of caregivers. These interventions should facilitate access to disease and treatment-related information, provide emotional support, and train coping skills to prevent burden and promote healthy adjustment to the demands of ESRD care.

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

BACKGROUND

People affected by kidney failure receiving haemodialysis experience complexity within their health condition unlike any other chronic illness or condition. Kidney failure impacts the individual in all areas of their life including relationships and activities of daily living.

OBJECTIVE

To conduct a meta-aggregation of studies about the lived experiences of people with kidney failure receiving haemodialysis.

DESIGN

Using PRISMA Guidelines, six databases (CINAHL, ClinicalTrials.gov, Cochrane Library, MEDLINE, PsycINFO, and Scopus) were comprehensively searched using keywords and subject headings from January 1990 to October 2021. Articles were assessed according to prespecified eligibility criteria. Data extraction and quality appraisal was conducted. A meta-aggregation of qualitative findings was conducted using the Joanna Briggs Institute methodology for meta-aggregation.

RESULTS

Of the 9409 articles screened, 55 studies were included. This represented a total of 188 findings across 45 categories representing a range of unmet supportive care needs. The meta-aggregation identified 11 synthesised findings broadly related to psychological/emotional needs, physical needs, social needs, interpersonal/intimacy needs, patient-clinician communication needs, family related needs, health system/information needs, spiritual needs, daily living needs, practical needs and daily living needs.

CONCLUSIONS

This meta-aggregation has identified that people affected by kidney failure can experience a range of unmet supportive care needs. It was evident that living with kidney failure and receiving haemodialysis impacted a person's sense of self, introduced practical needs and other complex needs which were not being addressed in existing services. This review has highlighted important implications for clinical practice and future research directions.

A family-centred perspective on the arteriovenous fistula in end-stage renal disease: Findings from dyadic interviews

INTRODUCTION

The preservation of a well-functioning arteriovenous fistula (AVF) is crucial for successful dialysis in patients with end-stage renal disease (ESRD); nonetheless, complications are frequent which leads to lower quality of life, hospitalisations and death. Self-care behaviours help to reduce the risk of complications and family caregivers can play an important role as partners for behaviour change. However, the patient and family caregiver's experiences with such an invasive intervention are largely unknown.

AIMS

This study aimed to explore the experiences of patients with ESRD and their family caregivers with the AVF through joint interviews.

METHODS

A qualitative exploratory study was conducted with a purposive sample. Semi-structured joint interviews were conducted with 14 dyads (28 participants) composed of patients on haemodialysis with AVF and their respective family caregivers. Interviews were audiotaped, transcribed verbatim and submitted to thematic analysis.

FINDINGS

Four major themes were identified: (i) AVF negative impacts; (ii) (un)presence of self-care behaviours; (iii) AVF self-management facilitators and (iv) AVF self-management barriers.

DISCUSSION

The findings suggested that more attention needs to be paid to patients' and their family caregivers' support needs (e.g. fears, concerns, knowledge, adherence barriers and facilitators) regarding AVF self-management. The dyads seem to be aware of how to take care of the AVF; however, self-care behaviours still need to be improved.

CONCLUSION

Innovative interventions need to follow an interdisciplinary approach with an educational and support component. The integration of family caregivers should also be considered, since this study evidenced their lack of knowledge and skills, and willingness to participate in these initiatives.