Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis: An Interview Study

Jessica Stevenson; Allison Tong; Talia Gutman; Katrina L Campbell; Jonathan C Craig; Mark A Brown; Vincent W Lee

doi:10.1053/j.jrn.2018.02.005

Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis: An Interview Study

J Ren Nutr. 2018 Nov;28(6):411-421. doi: 10.1053/j.jrn.2018.02.005. Epub 2018 Apr 22.

Authors

Jessica Stevenson¹, Allison Tong², Talia Gutman², Katrina L Campbell³, Jonathan C Craig², Mark A Brown⁴, Vincent W Lee⁵

Affiliations

¹ Western Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia. Electronic address: jste2727@uni.sydney.edu.au.
² Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
³ Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
⁴ Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia.
⁵ Western Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.

PMID: 29691161
DOI: 10.1053/j.jrn.2018.02.005

Abstract

Objectives: Diet and fluid management can reduce mortality, serious comorbidities, and debilitating symptoms in patients on hemodialysis, but restrictions may also be a major burden, and nonadherence remains high. We aimed to describe the perspectives and experiences of patients on hemodialysis regarding their dietary management to understand both facilitators and barriers to adherence and to identify strategies to improve care.

Design and methods: Semi-structured interviews were conducted with 35 people on maintenance hemodialysis from six dialysis units in New South Wales, Australia. Transcripts were thematically analyzed using principles of grounded theory.

Results: We identified 5 major themes. Two themes reflect barriers to dietary change: exacerbating disruption (adding to treatment burden, contradicting healthy eating, confused by fragmented advice, conflicting cultural norms, changing appetite and palate, isolation from family and friends) and losing control (crises derailing discipline, frustrated by failure, combating bodily need for hydration). Three themes represent enablers for dietary change: attaining health benefits (avoiding medical catastrophes, enhancing benefits of dialysis, alleviating and managing symptoms, improving health), achieving treatment goals (building familiarity and acceptance, flexibility and moderation, taking personal responsibility), and succeeding withsupport (leaning on family for strength, trusting expert guidance, empowered with flexible and practical advice, relying on reminders and cues, motivation through shared experience).

Conclusions: Patients on hemodialysis believe dietary control helps to reduce symptom burden and enhance general health and well-being, but competing medical and social issues coupled with contradictory and/or irrelevant dietary advice prevents them from implementing diet and fluid restrictions. Interventions involving collaborative multidisciplinary care including clinicians with dietetic expertise, and consistent information that addresses cultural and personal circumstances, may support adherence to dietary recommendations and improve outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Diet / methods*
Female
Humans
Interviews as Topic*
Male
Middle Aged
New South Wales
Patient Compliance / statistics & numerical data*
Renal Dialysis*
Renal Insufficiency, Chronic / diet therapy*
Renal Insufficiency, Chronic / therapy
Young Adult