Nephrologists’ perspectives on communication and decision-making regarding technique survival in peritoneal dialysis: an international qualitative interview study
Karine Manera,
David Johnson,
Jonathan Craig,
Saraladevi Naicker,
Chandana Guha,
Jeffrey Perl,
Angela Yee-Moon Wang,
Jie Dong,
Yeoungjee Cho,
Martin Wilkie,
Edwina Brown,
Roberto Pecoits-Filho,
Jenny Shen,
Allison Jauré,
Benedicta Yudianto,
Tony Dunning,
Rajnish Mehrotra,
Nicole Scholes-Robertson
Affiliations
Karine Manera
Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW, Australia
David Johnson
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Jonathan Craig
College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
Saraladevi Naicker
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Chandana Guha
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
Jeffrey Perl
Division of Nephrology, Department of Medicine, St. Michael`s Hospital, University of Toronto, Toronto, Ontario, Canada
Angela Yee-Moon Wang
Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
Jie Dong
Department of Medicine, Peking University First Hospital, Beijing, People`s Republic of China
Yeoungjee Cho
Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
Martin Wilkie
Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Edwina Brown
Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
Roberto Pecoits-Filho
Pontifical Catholic University of Parana, Curitiba, Brazil
Jenny Shen
The Lundquist Institute, Harbor-UCLA Medical Centre, Torrance, California, USA
Allison Jauré
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
Benedicta Yudianto
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
Tony Dunning
South Bank TAFE, Brisbane, Queensland, Australia
Rajnish Mehrotra
Department of Medicine, University of Washington, Seattle, Washington, USA
Nicole Scholes-Robertson
Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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.
