title: Patient perspectives on fluid management in chronic hemodialysis.
abstract: OBJECTIVE
  We sought to describe the perspectives and experiences of chronic hemodialysis (CHD) patients regarding self-care and adherence to fluid restrictions.
  
  
  METHODS
  Semistructured focus groups.
  
  
  METHODS
  Two outpatient hemodialysis centers.
  
  
  METHODS
  Nineteen patients on chronic hemodialysis.
  
  
  METHODS
  Patients were asked a series of open-ended questions to encourage discussion about the management of fluid restriction within the broad categories of general knowledge, knowledge sources or barriers, beliefs and attitudes, self-efficacy, emotion, and self-care skills.
  
  
  METHODS
  We analyzed session transcripts using the theoretical framework of content analysis to identify themes generated by the patients.
  
  
  RESULTS
  Patients discussed both facilitators and barriers to fluid restriction, which we categorized into six themes: knowledge, self-assessment, psychological factors, social, physical, and environmental. Psychological factors were the most common barriers to fluid restriction adherence, predominantly involving lack of motivation. Knowledge was the most discussed facilitator with accurate self-assessment, positive psychological factors, and supportive social contacts also playing a role. Dialysis providers were most commonly described as the source of dialysis information (54%), but learning through personal experience was also frequently noted (28%).
  
  
  CONCLUSIONS
  Interventions to improve fluid restriction adherence of chronic hemodialysis patients should target motivational issues, assess and improve patient knowledge, augment social support, and facilitate accurate self-assessment of fluid status.
authors.affiliation: Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Smith
authors.forename: Melinda
authors.initials: M
authors.lastname: Coston
authors.forename: Kimberly
authors.initials: K
authors.lastname: Glock
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Cavanaugh
mesh_terms: D004327:Drinking Behavior; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology*; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D012944:Social Support; D014882:Water-Electrolyte Balance