title: DEVELOPING LIFE SKILLS IN HAEMODIALYSIS USING THE GUIDED SELF-DETERMINATION METHOD: A QUALITATIVE STUDY.
abstract: BACKGROUND
  Studies in patients with diabetes have shown that the guided self determination (GSD) method effectively improves patients' glycaemia control and life skills. As a pilot study in 2011 showed promising results of using parts of GSD adjusted to patients on haemodialysis (HD), we decided to develop and test a full-scale GSD for this patient group (GSD-HD).
  
  
  OBJECTIVE
  To study how a full-scale GSD-HD influenced the quality of relatedness between the patient and the GSD-HD nurse and the patients' ability to live well with end stage renal disease (ESRD).
  
  
  METHODS
  GSD-HD was developed through participatory research and evaluated qualitatively at five dialysis units in Denmark involving 31 patients and 16 nurses. The intervention lasted four months and comprised six sessions. Data consisting of semi-structured interviews with 13 patients were analysed using a mix of inductive and deductive thematic analysis.
  
  
  RESULTS
  A process of developing life skills was clearly identified in the changes accomplished by all 13 participants going through the GSD-HD intervention. Six themes showed that the changes involved the patients personally, their relationships with healthcare professionals and relatives and their self-management of ESRD: Deeper and more meaningful relationships, self-exploration of self-selected challenges, self-understanding as a condition for meaningful knowledge, ability to act in a self-determined way, feedback from action that accords with daily life skills and decision-making from professional to share.
  
  
  CONCLUSIONS
  The positive changes identified in this qualitative evaluation are promising and indicate that GSD-HD has a potential worthwhile to be tested further among patients with ESRD.
authors.affiliation: Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Finderup
authors.affiliation: Department of Medicine, Roskilde Hospital, Roskilde, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Bjerre
authors.affiliation: Department of Medicine, Lillebaelt Hospital, Lillebaelt, Denmark.
authors.forename: Aase
authors.initials: A
authors.lastname: Soendergaard
authors.affiliation: University College Metropol, Copenhagen, Denmark.
authors.forename: Mette Elisabeth
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: Research Unit Women's and Children's Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.|Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Zoffmann
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D026684:Personal Autonomy; D010865:Pilot Projects; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology*
keywords: Empowerment; Guided self-determination; Haemodialysis; Patient involvement; Self-determination; Self-management/self-care; Shared decision making