Patients' perspectives on the implementation of intra-dialytic cycling--a phenomenographic study

Abstract

Background: Adults undergoing haemodialysis have significantly reduced physical capacity and run a high risk of developing cardiovascular complications. Research has shown that intra-dialytic cycling has many evidence-based health effects, but implementation is rare within renal clinical practice. This may be due to several causes, and this study focuses on the patients' perspective. This perspective has seldom been taken into account when aiming to assess and improve the implementation of clinical research. The aim of this study was to describe how adults undergoing in-centre haemodialysis treatment experienced an implementation process of intra-dialytic cycling. It aimed to identify potential motivators and barriers to the implementation process from a patient perspective.

Methods: Maximum-variation purposive sampling was used. Data were collected until saturation, through semistructured interviews, which were analysed using phenomenography.

Results: The implementation of intra-dialytic cycling was experienced as positive, as it had beneficial effects on physical and psychological well-being. It was easy to perform and did not intrude on patients' spare time. These factors increased the acceptance of the implementation and supported the maintenance of intra-dialytic cycling as an evidence-based routine within their haemodialysis care. The patients did, however, experience some barriers to accepting the implementation of intra-dialytic cycling. These barriers were sometimes so strong that they outweighed the participants' knowledge of the advantages of intra-dialytic cycling and the research evidence of its benefits. The barriers sometimes also outweighed the participants' own wish to cycle. The barriers that we identified concerned not only the patients but also the work situation of the haemodialysis nurses.

Conclusions: Consideration of the motivators and barriers that we have identified can be used in direct care to improve the implementation of intra-dialytic cycling.

Figure 1

The descriptive categories and their inter-relationship. Green (circle 1 and its rectangles) symbolises motivators, while red (circle 2 and its rectangles) symbolises barriers. The grey zone between circles 1 and 2 represents the individuals who are considering accepting the implementation of intra-dialytic cycling (motivators) or not (barriers). The descriptive categories 3 and 4 are factors that can either work as motivators (and therefore bring the patients closer to circle 1 or cause them to remain in circle 1) or have the opposite effect and reinforce barriers (and therefore take the patient out from circle 1 towards circle 2 or make the patient more convinced to remain in circle 2). The particular effects of the factors in ovals 3 and 4 depend on the surrounding environment.