TY - JOUR
T1 - Nephrologists' perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America
T2 - a qualitative study
AU - Matus Gonzalez, Andrea
AU - Lorca, Eduardo
AU - Cabrera, Sebastian
AU - Hernandez, Alejandra
AU - Zúñiga-Sm, Carlos
AU - Sola, Laura
AU - Michea, Luis
AU - Ferreiro Fuentes, Alejandro
AU - Cervantes, Lilia
AU - Madero, Magdalena
AU - Teixeira-Pinto, Armando
AU - Wong, Germaine
AU - Craig, Jonathan
AU - Jaure, Allison
PY - 2023/5/12
Y1 - 2023/5/12
N2 - ObjectiveTo describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America. DesignTwenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes. Setting25 centres across nine countries in Latin America. ParticipantsNephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience. ResultsWe identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics). Conclusion Nephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.
AB - ObjectiveTo describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America. DesignTwenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes. Setting25 centres across nine countries in Latin America. ParticipantsNephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience. ResultsWe identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics). Conclusion Nephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.
KW - chronic renal failure
KW - COVID-19
KW - dialysis
KW - qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85159739868&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-062321
DO - 10.1136/bmjopen-2022-062321
M3 - Article
C2 - 37173110
AN - SCOPUS:85159739868
SN - 2044-6055
VL - 13
JO - BMJ Open
JF - BMJ Open
IS - 5
M1 - e062321
ER -
