1
|
Mackintosh L, Ormandy P, Busby A, Hawkins J, Klare R, Silver C, Da Silva-Gane M, Santhakumaran S, Bristow P, Sharma S, Wellsted D, Chilcot J, Sridharan S, Steenkamp R, Harris T, Muirhead S, Lush V, Afuwape S, Farrington K. Impact of COVID-19 on patient experience of kidney care: a rapid review. J Nephrol 2024; 37:365-378. [PMID: 38123835 PMCID: PMC11043167 DOI: 10.1007/s40620-023-01823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In March 2020, a pandemic state was declared due to SARS-COV-2 (COVID-19). Patients with kidney disease, especially those on replacement therapies, proved more susceptible to severe infection. This rapid literature review aims to help understand how the pandemic impacted patient experience of kidney care. METHODS It was conducted in accordance with Cochrane Rapid Review interim guidance. Search terms, 'coronavirus', 'kidney care', and 'patient-reported experience' and terms with similar semantic meaning, identified 1,117 articles in Medline, Scopus, and Worldwide Science. Seventeen were included in the narrative synthesis. RESULTS The findings were summarised into three themes: remote consultation and telemedicine (n = 9); psychosocial impact (n = 2); and patient satisfaction and patient-reported experience (n = 6). Patients were mostly satisfied with remote consultations, describing them as convenient and allowing avoidance of hospital visits. Anxieties included missing potentially important clinical findings due to lack of physical examination, poor digital literacy, and technical difficulties. Psychosocial impact differed between treatment modalities-transplant recipients expressing feelings of instability and dread of having to return to dialysis, and generally, were less satisfied, citing reduced ability to work and difficulty accessing medications. Those on home dialysis treatments tended to feel safer. Findings focused on aspects of patient experience of kidney care during the pandemic rather than a holistic view. CONCLUSIONS There was little direct evaluation of modality differences and limited consideration of health inequalities in care experiences. A fuller understanding of these issues would guide policy agendas to support patient experience during future public health crises.
Collapse
Affiliation(s)
- Lucy Mackintosh
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK.
| | | | - Amanda Busby
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Janine Hawkins
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | | | | | | | | | | | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | | | | | - Sarah Afuwape
- Royal Free London NHS Foundation Trust, London, UK
- UCL Division of Medicine, University College London, London, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
- Qualitative Data Analysis Services, Gillingham, UK
| |
Collapse
|
2
|
Oviedo Flores K, Stamm T, Alper SL, Ritschl V, Vychytil A. Challenges to dialysis treatment during the COVID-19 pandemic: a qualitative study of patients' and experts' perspectives. Front Psychol 2023; 14:1185411. [PMID: 38034282 PMCID: PMC10686285 DOI: 10.3389/fpsyg.2023.1185411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
Background The global COVID-19 pandemic transformed healthcare services in ways that have impacted individual physical and psychological health. The substantial health challenges routinely faced by dialysis-dependent patients with advanced kidney disease have increased considerably during the ongoing COVID-19 pandemic but remain inadequately investigated. We therefore decided to analyze and compare the perspectives of dialysis patients on their own needs and challenges during the COVID-19 pandemic with those of their professional healthcare providers through interviews with both groups. Methods Qualitative study of seven in-center hemodialysis patients, seven peritoneal dialysis patients, seven dialysis nurses, and seven physicians at the Medical University of Vienna between March 2020 and February 2021, involving content analysis of semi-structured interviews supported by a natural language processing technique. Results Among the main themes emerging from interviews with patients were: (1) concerns about being a 'high-risk patient'; (2) little fear of COVID-19 as a patient on hemodialysis; (3) questions about home dialysis as a better choice than in-center dialysis. Among the main themes brought up by physicians and nurses were: (1) anxiety, sadness, and loneliness of peritoneal dialysis patients; (2) negative impact of changes in clinical routine on patients' well-being; (3) telehealth as a new modality of care. Conclusion Preventive measures against COVID-19 (e.g., use of facemasks, distancing, isolation), the introduction of telemedicine, and an increase in home dialysis have led to communication barriers and reduced face-to-face and direct physical contact between healthcare providers and patients. Physicians did not perceive the full extent of patients' psychological burdens. Selection/modification of dialysis modality should include analysis of the patient's support network and proactive discussion between dialysis patients and their healthcare providers about implications of the ongoing COVID-19 epidemic. Modification of clinical routine care to increase frequency of psychological evaluation should be considered in anticipation of future surges of COVID-19 or currently unforeseen pandemics.
Collapse
Affiliation(s)
- Krystell Oviedo Flores
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
- Baxter Healthcare GmbH, Vienna, Austria
| | - Tanja Stamm
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Seth L. Alper
- Division of Nephrology, Beth Israel Deaconess Medical Center and Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Valentin Ritschl
- Institute of Outcomes Research, Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Andreas Vychytil
- Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
3
|
Natale P, Zhang J, Scholes-Robertson N, Cazzolli R, White D, Wong G, Guha C, Craig J, Strippoli G, Stallone G, Gesualdo L, Jaure A. The Impact of the COVID-19 Pandemic on Patients With CKD: Systematic Review of Qualitative Studies. Am J Kidney Dis 2023; 82:395-409.e1. [PMID: 37330133 PMCID: PMC10270732 DOI: 10.1053/j.ajkd.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
RATIONALE & OBJECTIVE COVID-19 disproportionately affects people with comorbidities, including chronic kidney disease (CKD). We describe the impact of COVID-19 on people with CKD and their caregivers. STUDY DESIGN A systematic review of qualitative studies. SETTING & STUDY POPULATIONS Primary studies that reported the experiences and perspectives of adults with CKD and/or caregivers were eligible. SEARCH STRATEGY & SOURCES MEDLINE, Embase, PsycINFO, CINAHL searched from database inception to October 2022. DATA EXTRACTION Two authors independently screened the search results. Full texts of potentially relevant studies were assessed for eligibility. Any discrepancies were resolved by discussion with another author. ANALYTICAL APPROACH A thematic synthesis was used to analyze the data. RESULTS Thirty-four studies involving 1,962 participants were included. Four themes were identified: exacerbating vulnerability and distress (looming threat of COVID-19 infection, intensifying isolation, aggravating pressure on families); uncertainty in accessing health care (overwhelmed by disruption of care, confused by lack of reliable information, challenged by adapting to telehealth, skeptical about vaccine efficacy and safety); coping with self-management (waning fitness due to decreasing physical activity, diminishing ability to manage diet, difficulty managing fluid restrictions, minimized burden with telehealth, motivating confidence and autonomy); and strengthening sense of safety and support (protection from lockdown restrictions, increasing trust in care, strengthened family connection). LIMITATIONS Non-English studies were excluded, and inability to delineate themes based on stage of kidney and treatment modality. CONCLUSIONS Uncertainty in accessing health care during the COVID-19 pandemic exacerbated vulnerability, emotional distress, and burden, and led to reduced capacity to self-manage among patients with CKD and their caregivers. Optimizing telehealth and access to educational and psychosocial support may improve self-management and the quality and effectiveness of care during a pandemic, mitigating potentially catastrophic consequences for people with CKD. PLAIN-LANGUAGE SUMMARY During the COVID-19 pandemic, patients with chronic kidney disease (CKD) faced barriers and challenges to accessing care and were at an increased risk of worsened health outcomes. To understand the perspectives about the impact of COVID-19 among patients with CKD and their caregivers, we conducted a systematic review of 34 studies involving 1,962 participants. Our findings demonstrated that uncertainty in accessing care during the COVID-19 pandemic exacerbated the vulnerability, distress, and burden of patients and impaired their abilities for self-management. Optimizing the use of telehealth and providing education and psychosocial services may mitigate the potential consequences for people with CKD during a pandemic.
Collapse
Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy; Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Jing Zhang
- Centre for Kidney Research, Children's Hospital at Westmead, Australia; Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Nicole Scholes-Robertson
- Centre for Kidney Research, Children's Hospital at Westmead, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Rosanna Cazzolli
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Australia
| | - David White
- American Association of Kidney Patients, Tampa, Florida
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Australia; Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Chandana Guha
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Allison Jaure
- Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Australia
| |
Collapse
|
4
|
Patel S, Trujillo Rivera EA, Raman VK, Faselis C, Wang V, Fink JC, Roseman JM, Morgan CJ, Zhang S, Sheriff HM, Heimall MS, Wu WC, Zeng-Treitler Q, Ahmed A. Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis. Am J Nephrol 2023; 54:508-515. [PMID: 37524062 PMCID: PMC10959175 DOI: 10.1159/000532105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION According to the US Renal Data System (USRDS), patients with end-stage kidney disease (ESKD) on maintenance dialysis had higher mortality during early COVID-19 pandemic. Less is known about the effect of the pandemic on the delivery of outpatient maintenance hemodialysis and its impact on death. We examined the effect of pandemic-related disruption on the delivery of dialysis treatment and mortality in patients with ESKD receiving maintenance hemodialysis in the Veterans Health Administration (VHA) facilities, the largest integrated national healthcare system in the USA. METHODS Using national VHA electronic health records data, we identified 7,302 Veterans with ESKD who received outpatient maintenance hemodialysis in VHA healthcare facilities during the COVID-19 pandemic (February 1, 2020, to December 31, 2021). We estimated the average change in the number of hemodialysis treatments received and deaths per 1,000 patients per month during the pandemic by conducting interrupted time-series analyses. We used seasonal autoregressive moving average (SARMA) models, in which February 2020 was used as the conditional intercept and months thereafter as conditional slope. The models were adjusted for seasonal variations and trends in rates during the pre-pandemic period (January 1, 2007, to January 31, 2020). RESULTS The number (95% CI) of hemodialysis treatments received per 1,000 patients per month during the pre-pandemic and pandemic periods were 12,670 (12,525-12,796) and 12,865 (12,729-13,002), respectively. Respective all-cause mortality rates (95% CI) were 17.1 (16.7-17.5) and 19.6 (18.5-20.7) per 1,000 patients per month. Findings from SARMA models demonstrate that there was no reduction in the dialysis treatments delivered during the pandemic (rate ratio: 0.999; 95% CI: 0.998-1.001), but there was a 2.3% (95% CI: 1.5-3.1%) increase in mortality. During the pandemic, the non-COVID hospitalization rate was 146 (95% CI: 143-149) per 1,000 patients per month, which was lower than the pre-pandemic rate of 175 (95% CI: 173-176). In contrast, there was evidence of higher use of telephone encounters during the pandemic (3,023; 95% CI: 2,957-3,089), compared with the pre-pandemic rate (1,282; 95% CI: 1,241-1,324). CONCLUSIONS We found no evidence that there was a disruption in the delivery of outpatient maintenance hemodialysis treatment in VHA facilities during the COVID-19 pandemic and that the modest rise in deaths during the pandemic is unlikely to be due to missed dialysis.
Collapse
Affiliation(s)
- Samir Patel
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University, Washington, DC, USA
| | - Eduardo A. Trujillo Rivera
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Pediatrics, Georgetown University, Washington, DC, USA
| | - Venkatesh K. Raman
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Charles Faselis
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University, Washington, DC, USA
- Department of Medicine, Uniformed Services University, Washington, DC, USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Departments of Population Health Sciences and Medicine, Duke University, Baltimore, MD, USA
| | - Jeffrey C. Fink
- Veterans Affairs Medical Center, Baltimore, MD, USA
- Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jeffrey M. Roseman
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charity J. Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sijian Zhang
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
| | - Helen M. Sheriff
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Clinical Research and Leadership and Biomedical Informatics Center, George Washington University, Washington, DC, USA
| | - Michael S. Heimall
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
| | - Wen-Chih Wu
- Medical service, Veterans Affairs Medical Center, Providence, RI, USA
- Department of Medicine, Brown University, Providence, RI, USA
| | - Qing Zeng-Treitler
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Clinical Research and Leadership and Biomedical Informatics Center, George Washington University, Washington, DC, USA
| | - Ali Ahmed
- Center for Data Science and Outcomes Research, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Medicine, George Washington University, Washington, DC, USA
- Department of Medicine, Georgetown University, Washington, DC, USA
- Clinical Research and Leadership and Biomedical Informatics Center, George Washington University, Washington, DC, USA
| |
Collapse
|
5
|
Noce EM, Brereton L, Zorzanello M, Aklilu A, Anders E, Bernal M, Sundararajan A, Dahl NK, Kodali R, Patel DM. Dialysis Patient Experiences During the COVID-19 Pandemic: A Survey Study. Kidney Med 2023; 5:100673. [PMID: 37305377 PMCID: PMC10186967 DOI: 10.1016/j.xkme.2023.100673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Rationale & Objective The coronavirus disease 2019 (COVID-19) pandemic imposed several changes in the care of patients with kidney failure receiving dialysis. We explored patient care experiences during the pandemic. Study Design The study team verbally administered surveys including Likert scale multiple-choice questions and open-ended questions and recorded responses. Setting & Participants Surveys were administered to adults receiving dialysis through an academic nephrology practice after the first wave of the COVID-19 pandemic. Exposure Outpatient dialysis treatment during the COVID-19 pandemic. Outcomes Perceptions of care and changes in health. Analytical Approach Multiple-choice responses were quantified using descriptive statistics. Thematic analysis was used to code open-ended responses and derive themes surrounding patient experiences. Results A total of 172 patients receiving dialysis were surveyed. Most patients reported feeling "very connected" to the care teams. Seventeen percent of participants reported transportation issues, 6% reported difficulty obtaining medications, and 9% reported difficulty getting groceries. Four themes emerged as influencing patient experiences during the pandemic: 1) the COVID-19 pandemic did not significantly affect participants' experience of dialysis care; 2) the COVID-19 pandemic significantly impacted other aspects of participants' lives, which in turn were felt to affect mental and physical health; 3) regarding dialysis care experience more generally, participants valued consistency, dependability, and personal connection to staff; and 4) the COVID-19 pandemic highlighted the importance of external social support. Limitations Surveys were administered early in the COVID-19 pandemic, and patient perspectives have not been reassessed. Further qualitative analysis using semi-structured interviews was not performed. Survey distribution in additional practice settings, using validated questionnaires, would increase generalizability of the study. The study was not powered for statistical analysis. Conclusions Early in the COVID-19 pandemic, perceptions of dialysis care were unchanged for most patients. Other aspects of participants' lives were impacted, which affected their health. Subpopulations of patients receiving dialysis may be more vulnerable during the pandemic: those with histories of mental health conditions, non-White patients, and patients treated by in-center hemodialysis. Plain-language summary Patients with kidney failure continue to receive life-sustaining dialysis treatments during the coronavirus disease 2019 (COVID-19) pandemic. We sought to understand perceived changes in care and mental health during this challenging time. We administered surveys to patients receiving dialysis after the initial wave of COVID-19, asking questions on topics including access to care, ability to reach care teams, and depression. Most participants did not feel that their dialysis care experiences had changed, but some reported difficulties in other aspects of living such as nutrition and social interactions. Participants highlighted the importance of consistent dialysis care teams and the availability of external support. We found that patients who are treated with in-center hemodialysis, are non-White, or have mental health conditions may have been more vulnerable during the pandemic.
Collapse
Affiliation(s)
- Elyssa M. Noce
- Department of Internal Medicine, Section of Nephrology, Yale-New Haven Hospital, New Haven, Connecticut
| | - Laura Brereton
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mary Zorzanello
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Abinet Aklilu
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | | | - Melia Bernal
- School of Nursing, Yale University, New Haven, Connecticut
- School of Public Health, Yale University, New Haven, Connecticut
| | - Anusha Sundararajan
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Neera K. Dahl
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Ravi Kodali
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Dipal M. Patel
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Division of Nephrology, Johns Hopkins Medicine, Baltimore, Maryland
| |
Collapse
|
6
|
Affdal A, Malo MF, Blum D, Ballesteros F, Beaubien-Souligny W, Caron ML, Nadeau-Fredette AC, Vasilevsky M, Rios N, Suri RS, Fortin MC. Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network. KIDNEY360 2023; 4:188-197. [PMID: 36821610 PMCID: PMC10103388 DOI: 10.34067/kid.0004252022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Key Points Hemodialysis workers' well-being and work were affected by the COVID-19 pandemics. Effective communication strategies and taking into account psychological distress are ways to mitigate the challenges faced by health care workers. Background The COVID-19 pandemic has disrupted health systems and created numerous challenges in hospitals worldwide for patients and health care workers (HCWs). Hemodialysis centers are at risk of COVID-19 outbreaks given the difficulty of maintaining social distancing and the fact that hemodialysis patients are at higher risk of being infected with COVID-19. During the COVID-19 pandemic, HCWs have had to face many challenges and stressors. Our study was designed to gain HCWs' perspectives on their experiences of the impacts of the COVID-19 pandemic in hemodialysis units. Methods Semistructured interviews were conducted with 22 HCWs (nurses, nephrologists, pharmacists, social workers, patient attendants, and security agents) working in five hemodialysis centers in Montreal, between November 2020 and May 2021. The content of the interviews was analyzed using thematic analysis. Results Four themes were identified during the interviews. The first was the impact of COVID-19 on work organization, regarding which participants reported an increased workload, a need for a consistent information strategy, and positive innovations such as telemedicine. The second theme was challenges associated with communicating and caring for dialysis patients during the pandemic. The third theme was psychological distress experienced by hemodialysis staff and the psychosocial impact of COVID-19 on their personal lives. The fourth theme was recommendations made by participants for future public health emergencies, such as maintaining public health measures, ensuring an adequate supply of protective equipment, and developing a consistent communication strategy. Conclusions During the first and second waves of the COVID-19 pandemic, HCWs working in hemodialysis units faced multiple challenges that affected their well-being and their work. To minimize challenges for HCWs in hemodialysis during a future pandemic, the health care system should provide an adequate supply of protective equipment, develop effective communication strategies, and take into account the psychological distress related to HCWs' professional and personal lives.
Collapse
Affiliation(s)
- Aliya Affdal
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Dan Blum
- Division of nephrology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - William Beaubien-Souligny
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Line Caron
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | | | - Norka Rios
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Rita S. Suri
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Faculté de médecine de l'Université de Montréal, Montreal, Quebec, Canada
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| |
Collapse
|