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

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3 Citations (Scopus)

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 with support (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.

Original languageEnglish
Pages (from-to)411-421
Number of pages11
JournalJournal of Renal Nutrition
Volume28
Issue number6
DOIs
Publication statusPublished - 1 Nov 2018

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Renal Dialysis
Interviews
Dialysis
Diet
South Australia
New South Wales
Dietetics
Palate
Health
Appetite
Insurance Benefits
Cues
Comorbidity
Motivation
Maintenance
Mortality
Therapeutics

Cite this

Stevenson, Jessica ; Tong, Allison ; Gutman, Talia ; Campbell, Katrina L. ; Craig, Jonathan C. ; Brown, Mark A. ; Lee, Vincent W. / Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis : An Interview Study. In: Journal of Renal Nutrition. 2018 ; Vol. 28, No. 6. pp. 411-421.
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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 with support (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.",
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Experiences and Perspectives of Dietary Management Among Patients on Hemodialysis : An Interview Study. / Stevenson, Jessica; Tong, Allison; Gutman, Talia; Campbell, Katrina L.; Craig, Jonathan C.; Brown, Mark A.; Lee, Vincent W.

In: Journal of Renal Nutrition, Vol. 28, No. 6, 01.11.2018, p. 411-421.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - 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 with support (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.

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