TY - JOUR
T1 - Nephrologists' perspectives on communication and decision-making regarding technique survival in peritoneal dialysis
T2 - An international qualitative interview study
AU - Yudianto, Benedicta
AU - Jaure, Allison
AU - Shen, Jenny
AU - Cho, Yeoungjee
AU - Brown, Edwina
AU - Dong, Jie
AU - Dunning, Tony
AU - Mehrotra, Rajnish
AU - Naicker, Saraladevi
AU - Pecoits-Filho, Roberto
AU - Perl, Jeffrey
AU - Wang, Angela Yee Moon
AU - Wilkie, Martin
AU - Guha, Chandana
AU - Scholes-Robertson, Nicole
AU - Craig, Jonathan
AU - Johnson, David
AU - Manera, Karine
PY - 2024/3/11
Y1 - 2024/3/11
N2 - Objectives Peritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a major challenge for nephrologists. This study aims to describe nephrologists' perspectives on technique survival in PD. Design Qualitative semistructured interview study. Transcripts were thematically analysed. Setting and participants 30 nephrologists across 11 countries including Australia, the USA, the UK, Hong Kong, Canada, Singapore, Japan, New Zealand, Thailand, Colombia and Uruguay were interviewed from April 2017 to November 2019. Results We identified four themes: defining patient suitability (confidence in capacity for self-management, ensuring clinical stability and expected resilience), building endurance (facilitating access to practical support, improving mental well-being, optimising quality of care and training to reduce risk of complications), establishing rapport through effective communications (managing expectations to enhance trust, individualising care and harnessing a multidisciplinary approach) and confronting fear and acknowledging barriers to haemodialysis (preventing crash landing to haemodialysis, facing concerns of losing independence and positive framing of haemodialysis). Conclusion Nephrologists reported that technique survival in PD is influenced by patients' medical circumstances, psychological motivation and positively influenced by the education and support provided by treating clinicians and families. Strategies to enhance patients' knowledge on PD and communication with patients about technique survival in PD are needed to build trust, set patient expectations of treatment and improve the process of transition off PD.
AB - Objectives Peritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a major challenge for nephrologists. This study aims to describe nephrologists' perspectives on technique survival in PD. Design Qualitative semistructured interview study. Transcripts were thematically analysed. Setting and participants 30 nephrologists across 11 countries including Australia, the USA, the UK, Hong Kong, Canada, Singapore, Japan, New Zealand, Thailand, Colombia and Uruguay were interviewed from April 2017 to November 2019. Results We identified four themes: defining patient suitability (confidence in capacity for self-management, ensuring clinical stability and expected resilience), building endurance (facilitating access to practical support, improving mental well-being, optimising quality of care and training to reduce risk of complications), establishing rapport through effective communications (managing expectations to enhance trust, individualising care and harnessing a multidisciplinary approach) and confronting fear and acknowledging barriers to haemodialysis (preventing crash landing to haemodialysis, facing concerns of losing independence and positive framing of haemodialysis). Conclusion Nephrologists reported that technique survival in PD is influenced by patients' medical circumstances, psychological motivation and positively influenced by the education and support provided by treating clinicians and families. Strategies to enhance patients' knowledge on PD and communication with patients about technique survival in PD are needed to build trust, set patient expectations of treatment and improve the process of transition off PD.
KW - Kidney disease
KW - Peritoneal dialysis
KW - Nephrology
UR - http://www.scopus.com/inward/record.url?scp=85187657535&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2023-082184
DO - 10.1136/bmjopen-2023-082184
M3 - Article
C2 - 38471683
AN - SCOPUS:85187657535
SN - 2044-6055
VL - 14
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e082184
ER -