Notaras Stephanie, Conti Janet
Department of Dietetics, Liverpool Hospital, Liverpool, New South Wales, Australia.
Western Sydney University, School of Social Sciences and Psychology, New South Wales, Australia.
J Ren Care. 2018 Dec;44(4):219-228. doi: 10.1111/jorc.12258. Epub 2018 Oct 23.
Dietary changes recommended for chronic kidney disease (CKD) stages 4-5 and concurrent diabetes are difficult to follow given the multitude of food and fluid restrictions aimed at reducing the rate of CKD progression. Reduced adherence is commonplace and there is limited literature on patients' experiences with dietary changes and potential strategies to overcome this.
Examine patients' experiences when adopting dietary changes recommended for CKD Stages 4-5 (pre-dialysis) and diabetes, and their perceptions of dietetic services and how they can be improved to assist them with dietary change.
An exploratory qualitative study was undertaken using a purposive sampling method from a dietetic pre-dialysis clinic. Participants were interviewed using a semi-structured interview style. Data were analysed using an inductive thematic analysis from a constructivist perspective.
Three themes were identified: (1) Negative motivation to change eating behaviour to avoid dialysis; (2) sustaining motivation for change is challenging due to a sense of loss and confusion to incorporate the dietary changes recommended and (3) support is needed for eating behaviour change.
These findings have implications for dietitians to enhance their understanding of the patient experience and improve their skills in motivational counselling. Development of dietitian-specific communication and nutrition counselling programmes are recommended to equip dietitians with skills to better support patients. CKD Stage 3 nutrition education programmes could be beneficial to promote earlier access to dietetic services and dietary recommendations.
对于慢性肾脏病（CKD）4 - 5期合并糖尿病患者所推荐的饮食改变难以遵循，因为有众多旨在降低CKD进展速度的食物和液体限制。依从性降低很常见，而关于患者饮食改变经历以及克服这一问题的潜在策略的文献有限。
研究患者在采用针对CKD 4 - 5期（透析前）和糖尿病所推荐的饮食改变时的经历，以及他们对营养服务的看法，以及如何改进营养服务以帮助他们进行饮食改变。
采用目的抽样法，从营养透析前诊所开展一项探索性定性研究。采用半结构化访谈方式对参与者进行访谈。从建构主义视角使用归纳主题分析法对数据进行分析。
确定了三个主题：（1）改变饮食行为以避免透析的消极动机；（2）由于对纳入推荐饮食改变存在失落感和困惑，维持改变的动机具有挑战性；（3）饮食行为改变需要支持。
这些发现对营养师有启示意义，有助于增强他们对患者经历的理解，并提高他们在动机咨询方面的技能。建议制定针对营养师的沟通和营养咨询计划，以使营养师具备更好地支持患者的技能。CKD 3期营养教育计划可能有利于促进更早获得营养服务和饮食建议。
