title: A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis.
abstract: Patients on in-center dialysis spend significant amounts of time in the dialysis unit; additionally, managing ESRD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis, their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesize the experiences of patients receiving in-center hemodialysis.
  
  
  
  We searched Embase, MEDLINE, CINAHL, PsychINFO, Google Scholar, and reference lists for primary qualitative studies published from 1995 to 2015 that explored the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted.
  
  
  
  Seventeen studies involving 576 patients were included in the synthesis. Four analytic themes were developed. The first theme (a new dialysis-dependent self) describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme (a restricted life) describes the physical and emotional constraints that patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future, and these contributed to the third theme (regaining control). The first three themes describe a potential for change through acceptance, adaption, and regaining a sense of control. The final theme (relationships with health professionals) describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity, and personalized support.
  
  
  
  Our synthesis has resulted in a framework that can be used to consider interventions to improve patients' experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships that patients have with their health care professionals may enable patients to progress toward a sense of control and improve satisfaction with care.
authors.affiliation: Supportive Care, Early Diagnosis and Advanced Disease Research Group, Hull York Medical School, University of York, York, United Kingdom; and.
authors.forename: Claire
authors.initials: C
authors.lastname: Reid
authors.affiliation: Supportive Care, Early Diagnosis and Advanced Disease Research Group, Hull York Medical School, University of York, York, United Kingdom; and.
authors.forename: Julie
authors.initials: J
authors.lastname: Seymour
authors.affiliation: York Hospitals National Health Service Trust.
authors.forename: Colin
authors.initials: C
authors.lastname: Jones
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000553:Ambulatory Care; D004032:Diet; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D017060:Patient Satisfaction; D011209:Power, Psychological; D011369:Professional-Patient Relations; D006435:Renal Dialysis / Q000523:psychology*; D012649:Self Concept; D058992:Social Participation; D013997:Time Factors
keywords: chronic kidney disease; hemodialysis; patient centered care; patient experience; patient satisfaction; qualitative research; quality of life; thematic synthesis