“If you can’t change it, don’t fight it” Coping with automated peritoneal dialysis for end-stage kidney disease: A qualitative study

Ms Emily Duncanson1,2,3, Prof Anna Chur-Hansen3, Associate Professor Shilpanjali Jesudason2,4,5

1ANZDATA Registry, Adelaide, Australia, 2Central and Northern Adelaide Renal and Transplantation Service (CNARTS) Clinical Research Group, Royal Adelaide Hospital, Adelaide, Australia, 3School of Psychology, University of Adelaide, Adelaide, Australia, 4Kidney Health Australia, , Australia, 5Adelaide Medical School, University of Adelaide, Adelaide, Australia

Introduction: People receiving peritoneal dialysis (PD) for end-stage kidney disease (ESKD) experience poorer quality of life than healthy individuals. Whilst the prevalence of psychosocial difficulties in dialysis cohorts is well documented, further investigation into how patients adjust to and cope with the challenges imposed by ESKD and dialysis is needed.

Methods: Qualitative study. Participants were recruited purposively through the renal unit of a public hospital in South Australia. Ten people receiving automated PD (APD) (5 females, 5 males) aged 31 to 77 years (M = 59.3) participated in a one-on-one qualitative interview. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed thematically.

Results: Five main themes representing participants’ experiences and perspectives of the psychosocial challenges resulting from ESKD and APD and coping with these were identified: 1) Resigned Acceptance, 2) Means to an End, 3) Navigating Emotional Impacts at Milestones and Transitions 4) Professional Support and 5) Social Support. Participants described increased psychological burden at CKD and end-stage kidney disease diagnoses, dialysis initiation, and during theatment decision-making. Themes demonstrate the various cognitive, behavioural and social factors that promote adaptive coping, treatment adherence and patient wellbeing.

Conclusions: People receiving APD for ESKD face daily and chronic psychosocial challenges. Psychological distress and poor coping may be heightened at key disease milestones and transition periods, or among individuals without a caregiver in the home. Further research may evaluate the role of education and psychosocial support interventions at dialysis initiation and other transitions periods throughout the trajectory of chronic kidney disease.


Biography:

Emily is a registered psychologist who works as a research officer at the Central and Northern Adelaide Renal and Transplantation Service (CNARTS) Clinical Research Group at the Royal Adelaide Hospital and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Her area of interest, health psychology, involves addressing the psychological aspects of physical illness and chronic disease from a biopsychosocial approach. Her clinical and research interests are in the psychological wellbeing and quality of life of people undergoing renal replacement therapies and that of their caregivers and family members. In her research, she is interested in exploring people’s lived experiences using qualitative methods, with an aim of improving psychosocial wellbeing and  care for people with kidney disease.

Needle phobia in home haemodialysis: The role of motivational interviewing

Ms Angela Daffey1, Mr Matthew Harvey1, Dr Louis  Huang1

1Eastern Health Integrated Renal Service, Box Hill, Melbourne, Australia

Introduction:

Needle phobia is a common issue amongst patients training for home haemodialysis.  A validated method of identifying patient barriers is through the use of motivational interviewing (MI). We discuss two cases using this technique.

Method:

A case study comparison of two Eastern Health renal patients with complex needle phobia issues was conducted (Mr B, 72 yo male, and Mrs T, 57yo female).  A multi-disciplinary team comprising the home dialysis nurses, doctor, dietitians and psychologist were involved in the patients’ home haemodialysis training. The psychologist used MI techniques during clinical interviews with the patients to help determine their motivations for home dialysis, and identify potential barriers.

Results:

Despite several occasions when he was ready to give up, Mr B successfully completed his home dialysis training and needles independently. He has been performing home dialysis for over two years. By contrast, Mrs T struggled to progress with her home dialysis training and made the decision to transfer to satellite haemodialysis. This was due to a combination of ongoing needling problems and psychosocial issues that made her home environment unsuitable. Her wishes were respected and supported by the home dialysis team.

Conclusion:

In both of these cases the multi-disciplinary home dialysis team provided a consistent model of care, following the principles of MI. According to the MI tenet “honouring patient autonomy” it is the patients who ultimately decide what they want to do.


Biography:

After many years of working as an accountant in the corporate sector, I sought a new direction and retrained as a health psychologist, graduating in 2013. I commenced in the role of renal psychologist with EHIRS in late 2016, and enjoy working with a combination of both dialysis and transplant patients. My previous job roles and areas of interest in the health psychology field include chronic pain and chronic disease management; health behaviour change; infertility and perinatal counselling; and oncology.

PD BUDDy: Using smartphone technology to improve patient care

Mrs Marnie Budd1, Mrs Robyn Rogers

1Metro South Health, Logan, Australia

Introduction:

Online health tracking is a new innovation used to engage patients in the management of their health condition, aiming to reduce their risk of complications.  Peritoneal Dialysis (PD) patients in the Logan unit documented vital health information in a simple exercise book, which was often incomplete or forgotten when a patient attended a PD clinic appointment. PD BUDDy was developed by Logan Hospital in collaboration with a prominent research organisation to create a smartphone app and web portal for PD patients and their clinicians.

The smartphone app will allow patients to record vital information such as prescription, ultrafiltration, blood pressure and weight. The recorded data is accessible to their clinical care team through the web portal and we believe that more accurate records enables more efficient and effective patient clinics, improved peritonitis rates and better patient self-management of their health in their own environment.

Method:

An open label feasibility study of PD BUDDy has recently been completed at the Logan Hospital Peritoneal Dialysis Unit, Queensland.

Results:

Patients and staff have provided positive feedback around the use of the portal. 100% of patients surveyed, strongly agreed that the app was easy to use and fitted well with their lifestyle. They would also recommend it to others with kidney disease. Clinically, both exit site infections and peritonitis episodes were improved in the group of patients using the app.

Conclusion:

PD BUDDy streamlines how patients’ record and store information, potentially leading to improved health outcomes and extending their adverse event free time on the home-based therapy.


Biography:

I am a clinical nurse at the Logan Hospital peritoneal dialysis unit.  I have been a renal nurse for 16 years and have specialised in peritoneal dialysis for the last 10years.  I am very passionate about improving our patients outcomes and making life as easy as possible for them, whilst aligning our practices with current technology

Exploring better ways to start dialysis. Show, Train, Reassure, Educate and Assess Month [STREAM-HD]

Prof John Agar1, RN Rosemary Simmonds1, RN Richard Knight1, A/Prof Christine Somerville1

1Renal Services, University Hospital Geelong, Barwon Health, , Australia

Introduction: The induction of new patients into haemodialysis (HD) programs is often poorly managed. Despite routine pre-dialysis education programs, incomplete engagement and/or frank denial of approaching HD dependence leaves many ill-prepared as they defer their decision till their pre-dialysis clock strikes midnight. Further, despite pre-dialysis attempts to identify potential ‘home’ from ‘facility’ suited patients, many patients and families still struggle to appreciate option nuances before their actual dialysis begins. We describe a Show, Train, Reassure, Educate, and Assess Month [STREAM-HD] that we think may add value to the pre-dialysis education paradigm, and help to increase home HD uptake.

Methods and Results: All patients new to HD spend up to their first month of dialysis in a 4-6 chair education and assessment (E&A) ‘pod’ sited within an existing but purpose-expanded home training unit (HTU). Exposed to skilled HTU staff, intensive but empathetic, one-on-one E&A during dialysis permits both staff and patient to understand/assess all options and potentials. Placing the STREAM process within the HTU environment crucially allows: (1) HTU staff to identify and home-enthuse patients suitable for home HD who may otherwise slide, uncaptured for home, into facility care; (2) undifferentiated new patients the opportunity to witness and learn from the ‘can-do’ attitudes of other home trainees, or from established home patients, first hand.

Conclusion: While too early to judge our SRTEAM-HD outcomes, feedback is strongly positive. We believe the STREAM-HD approach may offer a new and better way to identify home-possible patients and to grow the home haemodialysis pool.


Biography:

To come

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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