Patient perspectives on fluid management in chronic hemodialysis.
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.
Smith
Kimberly
K
Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
Coston
Melinda
M
Glock
Kimberly
K
Elasy
Tom A
TA
Wallston
Kenneth A
KA
Ikizler
T Alp
TA
Cavanaugh
Kerri L
KL
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