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Woei Ling T, Khuan L, Baharom A, Arshad MM. Exploring the lived and coping experiences of patients with kidney failure undergoing haemodialysis in Malaysian private hospitals. J Res Nurs 2024; 29:228-240. [PMID: 38883246 PMCID: PMC11179604 DOI: 10.1177/17449871241235627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Background Chronic kidney disease is associated with structural and functional abnormalities in the kidney caused by a range of different aetiologies. Purpose The study's purpose was to explore the lived and coping experiences of patients with kidney failure undergoing haemodialysis in three private hospitals in Malaysia. Methods Applying an interpretative phenomenological analysis using a hermeneutic phenomenological design to derive common meaning from participants lived and coping experiences. In the study, data were collected using a semi-structured interview guide from 15 purposefully sampled patients with kidney failure. Data were analysed using the interpretative phenomenological analysis principles. Results Patients with kidney failure reported emotional distress, life limitations, financial burdens, knowledge deficits and varying perceptions of the haemodialysis treatment. Body image changes, financial assistance, social support and hope were coping strategies used by patients with kidney failure. It was identified that patients with kidney failure used unique coping strategies such as applying perfume and using clothes to conceal the impact of haemodialysis on their bodies, which is not comprehensively discussed in published literature. Conclusion Nurses who deliver care to patients with kidney failure should focus on mitigating emotional distress, increasing knowledge related to kidney failure and improving perception of the haemodialysis treatment. Delivering and providing social support are indispensable nursing roles to help patients cope with haemodialysis treatment.
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Affiliation(s)
- Tan Woei Ling
- PhD candidate, Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Lee Khuan
- Senior Nursing Lecturer, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Anisah Baharom
- Senior Medical Lecturer, Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Mursyid Arshad
- Senior Lecturer, Department of Professional Development & Continuing Education, Faculty of Educational Studies, University Putra Malaysia, Serdang, Selangor, Malaysia
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Verberne WR, Stiggelbout AM, Bos WJW, van Delden JJM. Asking the right questions: towards a person-centered conception of shared decision-making regarding treatment of advanced chronic kidney disease in older patients. BMC Med Ethics 2022; 23:47. [PMID: 35477488 PMCID: PMC9047263 DOI: 10.1186/s12910-022-00784-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/18/2022] [Indexed: 12/18/2022] Open
Abstract
An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease (CKD), involving dialysis or conservative care. Shared decision-making (SDM) is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient’s values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient’s perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient’s relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD.
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Affiliation(s)
- Wouter R Verberne
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. .,Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Internal Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes J M van Delden
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Barrett TM, Green JA, Greer RC, Ephraim PL, Peskoe S, Pendergast JF, Hauer CL, Strigo TS, Norfolk E, Bucaloiu ID, Diamantidis CJ, Hill-Briggs F, Browne T, Jackson GL, Boulware LE. Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care. Kidney Med 2021; 3:905-915.e1. [PMID: 34939000 PMCID: PMC8664702 DOI: 10.1016/j.xkme.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients' preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Adults receiving nephrology care at CKD clinics in rural Pennsylvania. PREDICTORS Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. OUTCOMES Occurrence and extent of kidney replacement therapy discussions and participants' satisfaction with those discussions. ANALYTIC APPROACH Multivariable logistic regression to quantify associations between participants' characteristics and whether they had discussions. RESULTS The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m2. Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. LIMITATIONS Single health system study. CONCLUSIONS Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences.
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Affiliation(s)
- Tyler M. Barrett
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Jamie A. Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
- Kidney Health Research Institute, Danville, PA
| | - Raquel C. Greer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Patti L. Ephraim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jane F. Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Chelsie L. Hauer
- Center for Clinical Innovation, Institute for Advanced Application, Danville, PA
| | - Tara S. Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Evan Norfolk
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Ion Dan Bucaloiu
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Clarissa J. Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
- Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC
| | - George L. Jackson
- Center for Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
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Lived Experiences of Patients with Chronic Kidney Disease Receiving Hemodialysis in Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. Int J Nephrol 2021; 2021:6637272. [PMID: 34484835 PMCID: PMC8410445 DOI: 10.1155/2021/6637272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose Chronic kidney disease is a challenging disease and global public health problem. The burden of chronic kidney disease and hemodialysis is increasing in Ethiopia, but few studies explored the lived experiences of chronic kidney disease patients receiving hemodialysis. This study explored the lived experiences of chronic kidney disease patients receiving hemodialysis, in the Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar City, Northwest Ethiopia, 2019. Methods A phenomenological study design was conducted with 12 chronic kidney disease patients receiving hemodialysis between September 1 and October 30, 2019. A purposive sampling technique was used to select participants, and a semistructured in-depth interview guide was used to collect the data. The investigators audio-taped the interviews and then transcribed them verbatim. Finally, the transcribed data were imported to Atlas.ti™-7 software for coding, and then, thematic analysis was done. Transferability, dependability, credibility, and conformability were embedded to ensure data quality. Results In this study, six major themes were emerged: (1) the seriousness of the disease, (2) challenges to get hemodialysis, (3) financial constraint, (4) restricted life, (5) feeling of dependency, and (6) psychological impacts. Conclusion The restrictive nature of the disease affects a participant's financial status which makes it challenging to obtain the service and increases feelings of dependency. These circumstances impact the psychology of the participants. We would recommend that every patient with hemodialysis needs social and psychological support. We would also recommend the need to extend the study to other areas of the country to confirm or disconfirm the findings.
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