Patients' views regarding choice of dialysis modality
Patients' views regarding choice of dialysis modality
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DOI：
10.1093/ndt/gfn365
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发表时间：
2008-12-01
影响因子：
6.1
通讯作者：
Nielsen, Camilla P.
中科院分区：
文献类型：
--
作者：
Lee, Anne;Gudex, Claire;Nielsen, Camilla P.
背景资料。患者数量的增加给透析中心带来了压力，需要重新安排透析治疗。本研究探讨了患者使用不同透析方式的经验，并调查了与患者选择透析方式有关的问题，特别是“中心外”透析(即冠心病以外的透析方式)。对24名透析患者、3名透析前患者和18名亲属进行了6次焦点小组访谈。每个焦点组包括接受一种类型透析的患者，即CHD、自理CHD、HHD、CAPD/APD、AAPD或透析前患者。在半结构化访谈指南的基础上，小组讨论集中在透析方式的优缺点、所遇到的问题及其(可能的)解决方案以及患者对透析方式选择的参与。焦点小组参与者认为，每种透析方式都有其优点和缺点。灵活性、独立性和安全感是决定方式选择的关键因素，维持正常生活是主要目标。患者及其亲属希望参与选择方式，但需要真正提供中心外透析，包括专业支持和适当及时的教育，以鼓励更多地使用CHD以外的方式。没有一种单一的透析方式能为终末期肾病患者提供最好的解决方案。在没有绝对的临床禁忌症的情况下，所选择的治疗方法应该是最能适应患者对日常活动和生活方式的偏好的方法。要让更多的患者接受中心外透析，需要更多地关注透析前的患者，并更密切地考虑患者的喜好和当前的生活方式。
Background. Increasing patient numbers have resulted in pressure on dialysis centres and a need to reorganize dialysis treatment. This study explored patients' experiences with different dialysis modalities and investigated issues related to the patient's choice of modality, especially 'out-of-centre' dialysis (i.e. modalities other than CHD).Methods. Six focus group interviews were conducted with 24 dialysis patients, 3 pre-dialysis patients and 18 relatives. Each focus group comprised patients on one type of dialysis, i.e. CHD, self-care CHD, HHD, CAPD/APD, aAPD or pre-dialysis patients. Based on a semi-structured interview guide, the group discussions centred on advantages and disadvantages of dialysis modalities, problems experienced and their (possible) solutions and patient involvement in choice of modality.Results. The focus groups participants considered that each dialysis modality has its advantages and disadvantages. Flexibility, independence and feelings of security were key factors in determining choice of modality, with maintenance of a normal life being a major goal. Patients and their relatives want to participate in choice of modality, but a genuine offer of out-of-centre dialysis including professional support and appropriate and timely education is needed to encourage a greater use of modalities other than CHD.Conclusions. No single dialysis modality emerged as offering the best solution for patients with end-stage renal disease. In the absence of absolute clinical contraindications, the treatment of choice should be the modality that best accommodates the patients' preferences for their daily activities and lifestyle. A move towards more patients on out-of-centre dialysis requires a greater focus on pre-dialysis patients and closer consideration of patients' preferences and current lifestyle.