Children's and young people's experiences of chronic renal disease: a review of the literature, methodological commentary and an alternative proposal

Young adults with chronic kidney disease: An exploration of their relationships and support networks

BACKGROUND

Young people with chronic kidney disease (CKD) have a number of key issues and life changes to manage while also possibly transitioning into adult care. During this time, the nature of their support networks including, social, romantic, family and health care relationships, is changing.

OBJECTIVE

To explore these young people's experience and perceptions of their past, current and future relationships and support networks.

DESIGN

Qualitative study.

PARTICIPANTS AND METHODS

Fourteen young adults (8 male, 6 female, aged 18-26 years) with CKD Stages 3-5 participated. Semi-structured interviews were conducted in order to explore the relationships (friends, family and partners) of young adults with CKD at two UK NHS hospitals. These were transcribed and thematically analysed.

RESULTS

There were four themes identified. 'Disclosure-To tell or not to tell?' identified the challenges young adults face when disclosing their condition to friends and prospective partners. 'Managing support networks' showed that participants appreciated support from other young adults with CKD but also desired just 'being normal' with their friends. While family support is still significant and much appreciated, some young adults also found it harder to develop their independence. 'Relationship strains and carer needs' highlights the impact of CKD on all relationships. Participants were also aware of the needs of their 'carers'. In 'Happy ever after?' young adults expressed concerns about meeting a partner and having children.

CONCLUSIONS

Young adults with CKD need support in helping them manage new and existing relationships, at a time where relationships are taking on different forms and significance. Moreover, support needs for young adults extend beyond the patient, to those who support them; support services need to reflect this.

'Skills for growing up': supporting autonomy in young people with kidney disease

BACKGROUND AND OBJECTIVES

End-stage kidney disease (ESKD) may interfere with children's developmental task of acquiring autonomy and participation. The Skills for Growing Up tool encourages normal development towards independence and autonomy during paediatric rehabilitation. This study aimed to adapt this self-management tool for use in paediatric nephrology, and to test whether its use is feasible in daily practice.

DESIGN AND PARTICIPANTS

A Delphi study was conducted among patients, their parents, professionals and experts to adjust the tool for use in nephrology. Feasibility was studied through individual and group interviews with professionals in all Dutch paediatric nephrology centres.

RESULTS

Agreement was reached on the areas of social participation and medical management of ESKD. Compared with the original, the new instrument holds considerable more attention for autonomy in the renal healthcare area; for example, dealing with medication and transplantation. Professionals used and appreciated the tool, but the paper form was seen to limit feasibility.

CONCLUSIONS

Making the tool available online is important. The challenge for professionals is to move beyond the focus on medical management and to consider developmental tasks when coaching their patients into adulthood.

APPLICATION TO PRACTICE

The Skills for Growing Up-Nephrology (SGU-N) tool is a promising instrument for use by professionals in paediatric nephrology. Its use can help young people achieving autonomy and may contribute to their successful transition to adulthood and adult care.

Effective peer-to-peer support for young people with end-stage renal disease: a mixed methods evaluation of Camp COOL

BACKGROUND

The Camp COOL programme aims to help young Dutch people with end-stage renal disease (ESRD) develop self-management skills. Fellow patients already treated in adult care (hereafter referred to as 'buddies') organise the day-to-day program, run the camp, counsel the attendees, and also participate in the activities. The attendees are young people who still have to transfer to adult care. This study aimed to explore the effects of this specific form of peer-to-peer support on the self-management of young people (16-25 years) with ESRD who participated in Camp COOL (CC) (hereafter referred to as 'participants').

METHODS

A mixed methods research design was employed. Semi-structured interviews (n = 19) with initiators/staff, participants, and healthcare professionals were conducted. These were combined with retrospective and pre-post surveys among participants (n = 62), and observations during two camp weeks.

RESULTS

Self-reported effects of participants were: increased self-confidence, more disease-related knowledge, feeling capable of being more responsible and open towards others, and daring to stand up for yourself. According to participants, being a buddy or having one positively affected them. Self-efficacy of attendees and independence of buddies increased, while attendees' sense of social inclusion decreased (measured as domains of health-related quality of life). The buddy role was a pro-active combination of being supervisor, advisor, and leader.

CONCLUSIONS

Camp COOL allowed young people to support each other in adjusting to everyday life with ESRD. Participating in the camp positively influenced self-management in this group. Peer-to-peer support through buddies was much appreciated. Support from young adults was not only beneficial for adolescent attendees, but also for young adult buddies. Paediatric nephrologists are encouraged to refer patients to CC and to facilitate such initiatives. Together with nephrologists in adult care, they could take on a role in selecting buddies.

'It is life threatening but I don't mind'. A qualitative study using photo elicitation interviews to explore adolescents' experiences of renal replacement therapies

BACKGROUND

Renal replacement therapy (RRT) transforms the life prospects of young people with established renal failure. However, these treatments can have significant physiological and psychological implications for adolescents as they prepare to transition into adulthood. Health policies increasingly emphasize children and youth's active participation and consultation as users of health services, yet studies infrequently seek their experiences directly.

METHODS

  Adolescents receiving RRT in a large UK teaching hospital took photographs illustrating the impact of their condition and treatment on their lives. Qualitative photo elicitation interviews were conducted to explore the significance of the images and the young person's experiences. Interviews were analysed using descriptive thematic analysis.

RESULTS

Ten young people aged 13-17 years participated. Themes identified were: (1) understanding and acceptance of treatment; (2) living in a non-functioning body; (3) impact upon daily life; (4) sources of support. Young people found treatments challenging and experienced significant impact on relationships and daily routines. Yet, health was prioritized over body image and participants demonstrated great emotional resilience. Young people valued support from family and friends, although were wary of disclosing their condition in case it resulted in being highlighted as different. Young people reported hospital staff as being caring and professional, but their biggest virtue appeared to be their willingness to treat the young people as 'normal'.

CONCLUSIONS

  Young people engaged readily with the research, and frankly described the impact of RRT on their everyday lives. Service providers must ensure that adolescents' developmental needs are met as traditional tasks of adolescence may lose priority. However, it is also clear that young people's ability to cope with treatments should not be underestimated.

The lived experiences of children and adolescents with end-stage renal disease

Relatively little is known about how children perceive and manage end-stage renal disease (ESRD) in daily life. To address this gap in the literature, the experiences and perceptions of children with ESRD were examined in this study. Study design comprised ethnographic interviews with 25 children and adolescents ages 7 to 18 years. Semistructured interviews were audiotaped, transcribed verbatim, and subjected to content analysis. Participants received a range of ESRD treatments including transplantation and dialysis. Findings indicate that ESRD has a profound impact on children. They described a range of challenges and experiences including not feeling "normal"; developing ESRD knowledge; frequent absence from school; gaining responsibility for ESRD care; relying on family, friends, and health care providers; and adjusting despite adversity. These findings depict a multifaceted, dynamic perspective engendered in tensions as children and adolescents grapple with adversity yet experience personal growth and resiliency. Implications and recommendations for clinical practice and research are discussed.

Experience of Hong Kong patients awaiting kidney transplantation in mainland China

AIM

This paper describes the experience of Hong Kong Chinese patients awaiting kidney transplantation in mainland China.

BACKGROUND

While travelling to mainland China for kidney transplantation is a controversial issue, there is an increasing trend of Hong Kong Chinese patients with chronic kidney disease seeking this treatment choice, which outnumbers that performed in Hong Kong. Although these patients seek pre- and post-transplantation care from Hong Kong public healthcare system, little is known about their experience during the waiting period.

METHODS

This experience is examined in an exploratory qualitative study. In-depth interviews were used to collect data from a purposive sample of 12 kidney recipients.

RESULTS

Three major findings are identified: (i) transplant waiting patients may travel to mainland China for transplantation in search of normal life, (ii) they need informational support from their continuing healthcare providers in Hong Kong to make the informed decision and (iii) they perceive a variation of attitudes of nurses and doctors in Hong Kong towards transplantation in mainland China.

CONCLUSIONS

This study contributes to the literature by researching patients' perspective. The findings highlight the importance and controversy of addressing these patients' informational needs. While the authors have no inclination for or against travelling to mainland China for transplantation, the findings reveal a tenacious clinical dilemma, which deserves debate in international transplant community and further research to inform the debate. Nurse and doctors in Hong Kong may contribute to the debate by articulating their experience of caring for these patients.

RELEVANCE TO CLINICAL PRACTICE

Health information that is readily available for patients scheduled for kidney transplantation in Hong Kong should be made accessible to the whole community of patients with chronic kidney disease. To address the complexity of patients travelling to elsewhere for transplantation and the needs of these patients, provider reticence may be counterproductive.