Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
J Pain Symptom Manage. 2019 Oct;58(4):578-586.e2. doi: 10.1016/j.jpainsymman.2019.06.010. Epub 2019 Jun 19.
Uremic pruritus, or itch, is common in people with chronic kidney disease (CKD) and has a negative impact on their lives and well-being. However, for reasons currently unknown, itch often remains unreported and therefore untreated.
To explore reasons for underreporting of itch to provide pointers for improving itch reporting and management in people with CKD.
We interviewed adult patients with CKD who self-reported experiencing itching in the last three years (n = 25), nephrologists (n = 10), and nurses (n = 12) from three kidney services in the U.K. Topic guides were informed by previous studies and a theoretical model of self-regulation. We conducted a thematic analysis of verbatim transcripts using framework analysis.
We identified the following three main themes reflecting factors that may influence whether itch is reported: knowledge on causes and treatment of itch (lack of awareness of the relationship between itch and CKD, and lack of knowledge of treatment options); attitudes toward importance of itch as a health issue (patients' and clinicians' attitudes); and prompts for itch assessment during consultations (routine practice, itch as a marker, and itch severity).
Underreporting of itch is related to patients being unaware of its causes, accepting it as something to live with, prioritizing other health issues, and the length and timing of consultations. Health care professionals' assessment and management of itch vary widely and are not necessarily evidence-based. Better patient information, development of clinical practice guidelines, and incorporation of routine symptom assessments into care may improve itch reporting and management in people with CKD.
尿毒症瘙痒，又称瘙痒，在慢性肾脏病（CKD）患者中很常见，对他们的生活和健康有负面影响。然而，由于目前尚不清楚的原因，瘙痒常常未被报告，因此也未得到治疗。
探讨瘙痒未被报告的原因，为改善 CKD 患者的瘙痒报告和管理提供线索。
我们采访了来自英国三个肾脏科的自我报告在过去三年中经历过瘙痒的成年 CKD 患者（n=25）、肾病医生（n=10）和护士（n=12）。主题指南的制定参考了先前的研究和自我调节的理论模型。我们使用框架分析对逐字记录进行了主题分析。
我们确定了以下三个主要主题，反映了可能影响瘙痒是否被报告的因素：瘙痒的病因和治疗知识（缺乏对瘙痒与 CKD 之间关系的认识，以及对治疗选择的了解有限）；对瘙痒作为健康问题重要性的态度（患者和临床医生的态度）；以及咨询期间瘙痒评估的提示（常规实践、瘙痒作为标志物和瘙痒严重程度）。
瘙痒未被报告与患者对其病因的无知、接受其作为生活的一部分、优先考虑其他健康问题以及咨询的长度和时间有关。医疗保健专业人员对瘙痒的评估和管理差异很大，不一定基于证据。更好的患者信息、制定临床实践指南以及将常规症状评估纳入护理中，可能会改善 CKD 患者的瘙痒报告和管理。
