title: The perspectives of adults living with peritoneal dialysis: thematic synthesis of qualitative studies.
abstract: BACKGROUND
  Most patients with end-stage renal disease require dialysis to survive because they are unable to access kidney transplantation. Peritoneal dialysis (PD) is recommended by some clinical practice guidelines as the dialysis treatment of choice for adults without significant comorbid conditions or those with residual kidney function. This study aims to synthesize published qualitative studies of patients' experiences, beliefs, and attitudes about PD.
  
  
  METHODS
  We conducted a systematic review and thematic synthesis of qualitative studies of adult perspectives of living with PD. Databases (MEDLINE, Embase, PsycINFO, and CINAHL), theses, and reference lists were searched to November 2011.
  
  
  RESULTS
  39 studies involving 387 participants were included. We identified 7 themes: resilience and confidence (determination and overcoming vicissitudes), support structures (strong family relationship, peer support, professional dedication, social abandonment, and desire for holistic care), overwhelming responsibility (disruptive intrusion, family burden, and onerous treatment regimen), control (gaining bodily awareness, achieving independence and self-efficacy, and information seeking), freedom (flexibility and autonomy, retaining social functioning, and ability to travel), sick identity (damage to self-esteem and invisible suffering), and disablement (physical incapacitation and social loss and devaluation).
  
  
  CONCLUSIONS
  PD can offer patients a sense of control, independence, self-efficacy, and freedom. However, holistic and multidisciplinary care is needed to mitigate the risks of impaired self-esteem, physical incapacitation, reduced social functioning, and poor sense of self-worth. Strategies that aim to strengthen social support and promote resilience and confidence in patients are integral to achieving positive adjustment, improved psychosocial outcomes, and treatment satisfaction.
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia. allison.tong@sydney.edu.au
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Brian
authors.initials: B
authors.lastname: Lesmana
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Denise
authors.initials: D
authors.lastname: Campbell
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D017281:Cost of Illness; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D010530:Peritoneal Dialysis / Q000523:psychology*; D036301:Qualitative Research; D055500:Resilience, Psychological; D020377:Self Efficacy; D012944:Social Support