Nephrologists' perspectives on communication and decision-making regarding technique survival in peritoneal dialysis: an international qualitative interview study

Abstract

Objectives: Peritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a major challenge for nephrologists. This study aims to describe nephrologists' perspectives on technique survival in PD.

Design: Qualitative semistructured interview study. Transcripts were thematically analysed.

Setting and participants: 30 nephrologists across 11 countries including Australia, the USA, the UK, Hong Kong, Canada, Singapore, Japan, New Zealand, Thailand, Colombia and Uruguay were interviewed from April 2017 to November 2019.

Results: We identified four themes: defining patient suitability (confidence in capacity for self-management, ensuring clinical stability and expected resilience), building endurance (facilitating access to practical support, improving mental well-being, optimising quality of care and training to reduce risk of complications), establishing rapport through effective communications (managing expectations to enhance trust, individualising care and harnessing a multidisciplinary approach) and confronting fear and acknowledging barriers to haemodialysis (preventing crash landing to haemodialysis, facing concerns of losing independence and positive framing of haemodialysis).

Conclusion: Nephrologists reported that technique survival in PD is influenced by patients' medical circumstances, psychological motivation and positively influenced by the education and support provided by treating clinicians and families. Strategies to enhance patients' knowledge on PD and communication with patients about technique survival in PD are needed to build trust, set patient expectations of treatment and improve the process of transition off PD.

Keywords: Dialysis; NEPHROLOGY; QUALITATIVE RESEARCH.

Figure 1

Thematic schema of nephrologists’ perspectives on technique survival in peritoneal dialysis (PD). Technique survival in PD may depend on patient clinical stability (peritoneal membrane function and residual kidney function), practical and psychological support available for them, patient education to prevent infection and nephrologists’ abilities to optimise patients’ longevity of PD. Developing effective communication by harnessing a multidisciplinary approach may also improve technique survival in PD, as it can guide patients’ expectations and adapt PD regimens based on patients’ priorities. Some patients are reluctant to change to haemodialysis, which might be caused by fear of losing independence and negative perceptions against haemodialysis. Smooth transition off PD might be achieved when clinicians were able to establish rapport with patients and manage patients’ expectations regarding treatment longevity.