Patient Perspectives on Fluid Management in Chronic Hemodialysis
published online 16 November 2009.
Objective
We sought to describe the perspectives and experiences of chronic hemodialysis (CHD) patients regarding self-care and adherence to fluid restrictions.
Design
Semistructured focus groups.
Setting
Two outpatient hemodialysis centers.
Participants
Nineteen patients on chronic hemodialysis.
Intervention
Patients were asked a series of open-ended questions to encourage discussion about the management of fluid restriction within the broad categories of general knowledge, knowledge sources or barriers, beliefs and attitudes, self-efficacy, emotion, and self-care skills.
Main outcome measure
We analyzed session transcripts using the theoretical framework of content analysis to identify themes generated by the patients.
Results
Patients discussed both facilitators and barriers to fluid restriction, which we categorized into six themes: knowledge, self-assessment, psychological factors, social, physical, and environmental. Psychological factors were the most common barriers to fluid restriction adherence, predominantly involving lack of motivation. Knowledge was the most discussed facilitator with accurate self-assessment, positive psychological factors, and supportive social contacts also playing a role. Dialysis providers were most commonly described as the source of dialysis information (54%), but learning through personal experience was also frequently noted (28%).
Conclusion
Interventions to improve fluid restriction adherence of chronic hemodialysis patients should target motivational issues, assess and improve patient knowledge, augment social support, and facilitate accurate self-assessment of fluid status.
∗Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37212
†Vanderbilt Eskind Diabetes Center, Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN 37232
‡VA Tennessee Valley Healthcare System, VA Quality Scholars Program, Nashville, TN 37212
§School of Nursing, Vanderbilt University Medical Center, Nashville, TN 37232
Address reprint requests to Kerri Cavanaugh, MD, MHS, 1161 21st Avenue, S-3223 Medical Center North, Nashville, TN 37232-2372.
Dr. Kimberly Smith is supported by NIH NIDDK grant T32DK007569. Dr. Cavanaugh is supported by a National Kidney Foundation Young Investigator Grant and by NIH NIDDK grant K23 DK080951-02. Dr. Elasy is supported by NIH NIDDK grant K24DK077875. P60DK020593. Dr. Ikizler is supported by NIH NIDDK grant K24DK062849. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) or the National Institutes of Health (NIH).
ABSTRACT