title: "Looking back to my family": indigenous Australian patients' experience of hemodialysis.
abstract: BACKGROUND
  In common with Indigenous populations elsewhere, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their non-Indigenous counterparts. Understanding how the demands of dialysis impact on, and are impacted by, the lives of Indigenous patients may provide important insight into treatment pathways and decision-making.
  
  
  METHODS
  We conducted semi-structured interviews in 2005-06 with 146 Indigenous and 95 non-Indigenous patients from nine hospital renal wards and 17 associated dialysis centres, which together treat the majority of Indigenous Australian ESKD patients.
  
  
  RESULTS
  Factors influencing treatment experience included: the impacts of late diagnosis; family separations associated with relocating for treatment; the physical and psychosocial demands of hemodialysis; and ineffective communication between health care providers and patients. Although not unique to them, Indigenous patients were more likely to experience the combined effect of all factors.
  
  
  CONCLUSIONS
  Social/situational circumstances profoundly affect Indigenous Australian dialysis patients' ability to fully engage with treatment. This may ultimately affect their likelihood of receiving optimal treatment, including transplantation. Areas for improvement include: earlier diagnosis; improved linkages between specialist renal services and primary care in regional settings; more effective communication and patient education; and more systematic, transparent approaches to patient "compliance" in transplant and home dialysis guidelines.
authors.affiliation: The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Anderson
authors.forename: Joan
authors.initials: J
authors.lastname: Cunningham
authors.forename: Jeannie
authors.initials: J
authors.lastname: Devitt
authors.forename: Cilla
authors.initials: C
authors.lastname: Preece
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
mesh_terms: D000328:Adult; D001315:Australia / Q000208:ethnology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D006435:Renal Dialysis / Q000523:psychology; D055815:Young Adult