title: Improving symptom management in hemodialysis patients: identifying barriers and future directions.
abstract: BACKGROUND
  Hemodialysis (HD) patients experience significant symptom burden that is often undertreated.
  
  
  OBJECTIVE
  This study identified (1) barriers to symptom management in the HD population, (2) potential targets for improving symptom burden, (3) provider attitudes toward palliative care for HD patients, and (4) perceptions of how transplant eligibility impacts care.
  
  
  METHODS
  Semistructured, one-on-one interviews were conducted, audiotaped, and transcribed. Data were analyzed qualitatively by two investigators to identify discrete themes.
  
  
  METHODS
  Health care providers (HCPs) and caregivers were recruited (June to October 2012) from three outpatient HD units in New York City.
  
  
  METHODS
  Open-ended questions were used with follow-up probes.
  
  
  RESULTS
  Interviews were completed with 34 HCPs (8 physicians, 2 nurse practitioners, 4 social workers, 13 registered nurses, 7 patient care technicians) and 20 caregivers (14 family members, 5 home health aides, 1 friend). Barriers to symptom control were identified in three areas: (1) provider unawareness of symptoms, (2) provider's uncertainty as to whose responsibility it is to treat symptoms, and (3) inherent difficulty in symptom management. Ideas for ameliorating symptoms included enhancing systems for patient/caregiver education, improving systems for HCP communication with other disciplines, and encouraging alternative methods of dialysis when appropriate. HCPs also expressed discomfort with the term "palliative care."
  
  
  CONCLUSIONS
  Renal HCPs are often unaware of the magnitude of symptom burden in their HD patients. This study found that there is lack of ownership for assessing and treating these symptoms. Providers also feel certain symptoms are "untreatable." Research is needed to develop effective treatment strategies for HD populations.
authors: 1 Division of Geriatrics, Weill Cornell Medical College , New York, New York.
authors: Rachel
authors: R
authors: Feldman
authors: Nathaniel
authors: N
authors: Berman
authors: M Cary
authors: MC
authors: Reid
authors: Jordan
authors: J
authors: Roberts
authors: Rouzi
authors: R
authors: Shengelia
authors: Kaylan
authors: K
authors: Christianer
authors: Brian
authors: B
authors: Eiss
authors: Ronald D
authors: RD
authors: Adelman
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D036301:Qualitative Research; D058996:Quality Improvement; D006435:Renal Dialysis / Q000592:standards*; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology* / Q000628:therapy