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Patient perspectives on the optimal start of renal replacement therapy.
J Ren Care. 2017 Sep; 43(3):143-155.JR

Abstract

BACKGROUND

Healthcare systems and providers are encouraged to prepare their patients with advanced chronic kidney disease (CKD) for a planned start to renal replacement therapies (RRT). Less well understood are the socioemotional experiences surrounding the optimal start of RRT versus suboptimal haemodialysis (HD) starts with a central catheter.

OBJECTIVES

To characterise the experiences of patients beginning RRT.

DESIGN

Qualitative, semi-structured phone interviews.

PARTICIPANTS

A total of 168 patients with stage 5 CKD initiating RRT in an integrated, capitated learning healthcare system.

APPROACH

Qualitative data from patients were collected as part of a quality improvement initiative to better understand patient-reported themes concerning preparation for RRT, patients' perceptions of their transition to dialysis and why sub-optimal starts for RRT occur within our healthcare system. Dual review and verification was used to identify key phrases and themes within and across each domain, using both deductive a priori codes generated by the interview guide and grounded discovery of emergent themes.

RESULTS

From the patient perspective, preparing for RRT is an experience rooted in deep feelings of fear. In addition, a number of key factors contributed to patients' preparation (or failure to prepare) for RRT. While the education provided by our system was viewed as adequate overall, patients often felt that their emotional and psychosocial needs went unmet, regardless of whether or not, they experienced an optimal dialysis start.

CONCLUSIONS

Future efforts should incorporate additional strategies for helping patients with advanced CKD achieve emotional and psychological safety while preparing for RRT.

Authors+Show Affiliations

Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA.Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, California, USA.Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts, USA.Kaiser Permanente Southern California Baldwin Park Medical Center, Baldwin Park, California, USA.Kaiser Permanente Southern California Baldwin Park Medical Center, Baldwin Park, California, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28393467

Citation

Henry, Shayna L., et al. "Patient Perspectives On the Optimal Start of Renal Replacement Therapy." Journal of Renal Care, vol. 43, no. 3, 2017, pp. 143-155.
Henry SL, Munoz-Plaza C, Garcia Delgadillo J, et al. Patient perspectives on the optimal start of renal replacement therapy. J Ren Care. 2017;43(3):143-155.
Henry, S. L., Munoz-Plaza, C., Garcia Delgadillo, J., Mihara, N. K., & Rutkowski, M. P. (2017). Patient perspectives on the optimal start of renal replacement therapy. Journal of Renal Care, 43(3), 143-155. https://doi.org/10.1111/jorc.12202
Henry SL, et al. Patient Perspectives On the Optimal Start of Renal Replacement Therapy. J Ren Care. 2017;43(3):143-155. PubMed PMID: 28393467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient perspectives on the optimal start of renal replacement therapy. AU - Henry,Shayna L, AU - Munoz-Plaza,Corrine, AU - Garcia Delgadillo,Jazmine, AU - Mihara,Nichole K, AU - Rutkowski,Mark P, Y1 - 2017/04/09/ PY - 2017/4/11/pubmed PY - 2018/5/22/medline PY - 2017/4/11/entrez KW - Advanced kidney disease KW - Haemodialysis KW - Optimal dialysis starts SP - 143 EP - 155 JF - Journal of renal care JO - J Ren Care VL - 43 IS - 3 N2 - BACKGROUND: Healthcare systems and providers are encouraged to prepare their patients with advanced chronic kidney disease (CKD) for a planned start to renal replacement therapies (RRT). Less well understood are the socioemotional experiences surrounding the optimal start of RRT versus suboptimal haemodialysis (HD) starts with a central catheter. OBJECTIVES: To characterise the experiences of patients beginning RRT. DESIGN: Qualitative, semi-structured phone interviews. PARTICIPANTS: A total of 168 patients with stage 5 CKD initiating RRT in an integrated, capitated learning healthcare system. APPROACH: Qualitative data from patients were collected as part of a quality improvement initiative to better understand patient-reported themes concerning preparation for RRT, patients' perceptions of their transition to dialysis and why sub-optimal starts for RRT occur within our healthcare system. Dual review and verification was used to identify key phrases and themes within and across each domain, using both deductive a priori codes generated by the interview guide and grounded discovery of emergent themes. RESULTS: From the patient perspective, preparing for RRT is an experience rooted in deep feelings of fear. In addition, a number of key factors contributed to patients' preparation (or failure to prepare) for RRT. While the education provided by our system was viewed as adequate overall, patients often felt that their emotional and psychosocial needs went unmet, regardless of whether or not, they experienced an optimal dialysis start. CONCLUSIONS: Future efforts should incorporate additional strategies for helping patients with advanced CKD achieve emotional and psychological safety while preparing for RRT. SN - 1755-6686 UR - https://www.unboundmedicine.com/medline/citation/28393467/Patient_perspectives_on_the_optimal_start_of_renal_replacement_therapy_ L2 - https://doi.org/10.1111/jorc.12202 DB - PRIME DP - Unbound Medicine ER -