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. 2023 Nov 15:14:1185411.
doi: 10.3389/fpsyg.2023.1185411. eCollection 2023.

Challenges to dialysis treatment during the COVID-19 pandemic: a qualitative study of patients' and experts' perspectives

Krystell Oviedo Flores  1   2 , Tanja Stamm  3   4 , Seth L Alper  5 , Valentin Ritschl #  3   4 , Andreas Vychytil #  1
Affiliations

Challenges to dialysis treatment during the COVID-19 pandemic: a qualitative study of patients' and experts' perspectives

Krystell Oviedo Flores et al. Front Psychol. .

Abstract

Background: The global COVID-19 pandemic transformed healthcare services in ways that have impacted individual physical and psychological health. The substantial health challenges routinely faced by dialysis-dependent patients with advanced kidney disease have increased considerably during the ongoing COVID-19 pandemic but remain inadequately investigated. We therefore decided to analyze and compare the perspectives of dialysis patients on their own needs and challenges during the COVID-19 pandemic with those of their professional healthcare providers through interviews with both groups.

Methods: Qualitative study of seven in-center hemodialysis patients, seven peritoneal dialysis patients, seven dialysis nurses, and seven physicians at the Medical University of Vienna between March 2020 and February 2021, involving content analysis of semi-structured interviews supported by a natural language processing technique.

Results: Among the main themes emerging from interviews with patients were: (1) concerns about being a 'high-risk patient'; (2) little fear of COVID-19 as a patient on hemodialysis; (3) questions about home dialysis as a better choice than in-center dialysis. Among the main themes brought up by physicians and nurses were: (1) anxiety, sadness, and loneliness of peritoneal dialysis patients; (2) negative impact of changes in clinical routine on patients' well-being; (3) telehealth as a new modality of care.

Conclusion: Preventive measures against COVID-19 (e.g., use of facemasks, distancing, isolation), the introduction of telemedicine, and an increase in home dialysis have led to communication barriers and reduced face-to-face and direct physical contact between healthcare providers and patients. Physicians did not perceive the full extent of patients' psychological burdens. Selection/modification of dialysis modality should include analysis of the patient's support network and proactive discussion between dialysis patients and their healthcare providers about implications of the ongoing COVID-19 epidemic. Modification of clinical routine care to increase frequency of psychological evaluation should be considered in anticipation of future surges of COVID-19 or currently unforeseen pandemics.

Keywords: COVID-19; anxiety; dialysis experts; hemodialysis; isolation; peritoneal dialysis; qualitative study.

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Conflict of interest statement

AV has received honoraria and travel grants from Baxter and Fresenius and consulting fees from Baxter unrelated to this study. KOF is a PhD. candidate at the Medical University of Vienna and an employee of Baxter Healthcare GmbH, funded as an early-stage researcher by the IMPROVE-PD (812699)/Horizon 2020 project. Baxter Healthcare did not participate in developing the protocol and study design, collection, analysis, or interpretation of data, the writing of this article, the decision to submit it for publication, or the financing of the study. SA is a consultant to the Medical University of Vienna. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Coding tree identified through content analysis and natural language processing (LDA) of the interviews of dialysis patients.
Figure 2
Figure 2
Coding tree identified through content analysis and natural language processing (LDA) of the interviews of nurses and physicians.
Figure 3
Figure 3
Distinctive themes identified in the four groups of participants.
See this image and copyright information in PMC

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