Raj Rajesh, Brown Bridget, Ahuja Kiran, Frandsen Mai, Jose Matthew
School of Medicine, University of Tasmania, Hobart, Australia.
Launceston General Hospital, Launceston, Tasmania, 7250, Australia.
BMC Nephrol. 2020 Jan 29;21(1):28. doi: 10.1186/s12882-020-1695-1.
Older patients on dialysis may not have optimal outcomes, particularly with regards to quality of life. Existing research is focused mainly on survival, with limited information about other outcomes. Such information can help in shared decision-making around dialysis initiation; it can also be used to improve outcomes in patients established on dialysis. We used qualitative research methods to explore patient perspectives regarding their experience and outcomes with dialysis.
Semi-structured interviews with participants aged ≥70, receiving dialysis at a regional Australian hospital, were recorded and transcribed. From participants' responses, we identified descriptive themes using a phenomenological approach, with verification by two researchers. Factors affecting outcomes were derived reflexively from these themes.
Seventeen interviews were analysed prior to saturation of themes. Participants (12 on haemodialysis, 5 on peritoneal dialysis) had spent an average of 4.3 years on dialysis. There were 11 males and 6 females, with mean age 76.2 years (range 70 to 83). Experiences of dialysis were described across four domains - the self, the body, effects on daily life and the influences of others; yielding themes of (i) responses to loss (of time, autonomy, previous life), (ii) responses to uncertainty (variable symptoms; unpredictable future; dependence on others), (iii) acceptance / adaptation (to life on dialysis; to ageing) and (iv) the role of relationships / support (family, friends and clinicians).
Older patients experience the effects of dialysis across multiple domains in their lives. They endure feelings of loss and persistent uncertainty, but may also adapt successfully to their new circumstances, aided by the support they receive from family, health professionals and institutions. From these insights, we have suggested practical measures to improve outcomes in older patients.
接受透析治疗的老年患者可能无法获得最佳治疗效果，尤其是在生活质量方面。现有研究主要集中在生存率上，关于其他治疗效果的信息有限。这些信息有助于在透析开始时进行共同决策；也可用于改善已接受透析治疗患者的治疗效果。我们采用定性研究方法，探讨患者对透析经历和治疗效果的看法。
对澳大利亚一家地区医院中年龄≥70岁且正在接受透析治疗的参与者进行半结构化访谈，并进行录音和转录。从参与者的回答中，我们采用现象学方法确定描述性主题，并由两名研究人员进行验证。影响治疗效果的因素是从这些主题中反推出来的。
在主题饱和之前，对17次访谈进行了分析。参与者（12人接受血液透析，5人接受腹膜透析）平均透析时间为4.3年。其中男性11人，女性6人，平均年龄76.2岁（年龄范围为70至83岁）。透析经历涵盖四个领域——自我、身体、对日常生活的影响以及他人的影响；产生的主题包括：（i）对损失（时间、自主权、以前的生活）的反应，（ii）对不确定性的反应（症状多变；未来不可预测；依赖他人），（iii）接受/适应（透析生活；衰老）以及（iv）人际关系/支持（家人、朋友和临床医生）的作用。
老年患者在生活的多个领域都感受到透析的影响。他们承受着失落感和持续的不确定性，但在家人、健康专业人员和机构的支持下，也可能成功适应新环境。基于这些见解，我们提出了改善老年患者治疗效果的实际措施。
