Facilitators and barriers to treatment with haemodialysis among persons in mid‐adulthood: an interpretative phenomenological analysis

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With the development of renal replacement therapies, the lives of persons with end‐stage renal disease (ESRD) have been prolonged 1. Haemodialysis (HD) treatment requires the patient to attend a hospital for about three times a week for a 3–4 hour session 2. During this treatment, waste products from the blood are removed into the dialysis fluid and then discarded 3. Due to an ageing population and the increased incidence of persons with cardiovascular disease and diabetes, the number of cases of persons on dialysis is rising by 5% per annum 4. However, nonadherence to HD treatment remains an issue, with estimates between 25% and 86% of patients nonadherent to their treatment 5. Furthermore, low levels of adherence have also been correlated with an increased risk of patient mortality 6.
Thus, health professionals face a major challenge in targeting the low adherence to treatment of patients with ESRD 7. Hence, there is a need to go beyond describing rates of adherence and explore reasons for nonadherence from the patients’ perspective 8. This is of particular relevance, as the illness perceptions of patients are potentially modifiable and have been linked to nonadherence and even survival in patients with ESRD 9. Furthermore, these illness perceptions play a critical part in evaluating the effectiveness of a coping procedure, such as undertaking HD 10. Such an evaluation would include determining barriers and facilitators affecting the successful performance of the treatment 11. As a consequence of this process, patients may then maintain or alter their illness perceptions, as well as their coping procedures. Hence, this study contributes to the available literature by exploring the perceived facilitators and barriers in undertaking HD, as there is a dearth of research regarding the treatment perceptions of individuals with ESRD 12.
To date, qualitative studies on persons undergoing HD for ESRD tend to focus on the quality of life of these individuals 13. Moreover, these studies often target heterogeneous groups of individuals in the early, mid and late phase of adulthood collectively 14. However, exploring the experiences of adults with HD collectively fails to acknowledge that their experiences are influenced by age 17, as different life issues are encountered at different phases of a person's life 13.
Hence, this study contributes to the available literature, by exploring the perceived barriers and facilitators to HD, in patients during mid‐adulthood. This phase is described as a contemporary phenomenon 19, usually lasting between the ages of 34 and 60 years 20. It is a stage during which there is an increased concern about one's body, as well as an increased reflection about the meaning of life 21. Moreover, the concerns experienced during mid‐adulthood are of particular relevance to persons on haemodialysis who express a loss of purpose in life 22, a sense of vulnerability 15 and changes in their body function and image 13. Consequently, there is a need to explore the patient's appraisal of their experience on HD, at a phase when adults are particularly susceptible to being negatively affected by this treatment. In addition, a review of the literature has indicated only one qualitative study 22 which focused specifically on the barriers and facilitators to treatment with HD in mid‐adulthood (39–63 years). The sample consisted of nine ethnic Chinese and four Malay patients who have been undergoing HD for 6 months or less. This study identified experiencing of negative symptoms (e.g. fatigue and muscle cramps), intrusion of haemodialysis on their preferred lifestyle (work and social life), time‐consuming treatment and the discomfort associated with needling of access sites as barriers to treatment.
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