Patients' Perspectives on the Prevention and Treatment of Peritonitis in Peritoneal Dialysis: A Semi-Structured Interview Study.
♦ BACKGROUND: Peritoneal dialysis (PD) is recommended for adults with residual kidney function and without significant comorbidities. However, peritonitis is a serious and common complication that is associated with hospitalization, pain, catheter loss, and death. This study aims to describe the beliefs, needs, and experiences of PD patients about peritonitis, to inform the training, support, and care of these patients. ♦ METHODS: Qualitative semi-structured interviews were conducted with 29 patients from 3 renal units in Australia who had previous or current experience of PD. The interviews were conducted between November 2014 and November 2015. Transcripts were analyzed thematically. ♦ RESULTS: We identified 4 themes: constant vigilance for prevention (conscious of vulnerability, sharing responsibility with family, demanding attention to detail, ambiguity of detecting infection, ineradicable inhabitation, jeopardizing PD success); invading harm (life-threatening, wreaking internal damage, debilitating pain, losing control and dignity); incapacitating lifestyle interference (financial strain, isolation and separation, exacerbating burden on family); and exasperation with hospitalization (dread of hospital admission, exposure to infection, gruelling follow-up schedule, exposure to harm). ♦ CONCLUSIONS: Patients perceived that peritonitis could threaten their health, treatment modality, and lifestyle, which motivated vigilance and attention to hygiene. They felt a loss of control due to debilitating symptoms including pain and having to be hospitalized, and they were uncertain about how to monitor for signs of peritonitis. Providing patients with education about the causes and signs of peritonitis and addressing their concerns about lifestyle impact, financial impact, hospitalization, and peritonitis-related anxieties may improve treatment satisfaction and outcomes for patients requiring PD.
Sydney School of Public Health, University of Sydney, Sydney, Australia denise.campbell@health.nsw.gov.au.|Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, Australia.
Denise J
DJ
Campbell
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, Australia.
Jonathan C
JC
Craig
Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.
David W
DW
Mudge
Department of Nephrology, Monash Medical Centre, Clayton, Australia.
Fiona G
FG
Brown
Sydney School of Public Health, University of Sydney, Sydney, Australia.
Germaine
G
Wong
Sydney School of Public Health, University of Sydney, Sydney, Australia.|Centre for Kidney Research, Sydney Children's Hospital Network (Westmead), Westmead, Australia.
Allison
A
Tong
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017053:Infection Control / Q000379:methods; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D011237:Predictive Value of Tests; D036301:Qualitative Research; D011788:Quality of Life; D018570:Risk Assessment; D018434:Sickness Impact Profile; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Peritoneal dialysis; peritonitis; qualitative research
Am J Kidney Dis. 2013 Jun;61(6):873-88
23177729
Perit Dial Int. 2011 Nov-Dec;31(6):614-30
21880990
Am J Kidney Dis. 1989 May;13(5):365-9
2719024
Perit Dial Int. 2008 Jun;28 Suppl 3:S53-8
18552265
Int J Qual Health Care. 2007 Dec;19(6):349-57
17872937
Nephrol Dial Transplant. 2001 Feb;16(2):341-7
11158410
Kidney Int Suppl. 2008 Apr;(108):S145-51
18379538
J Ren Care. 2015 Sep;41(3):177-86
25727142
Perit Dial Int. 2003 Dec;23 Suppl 2:S175-7
17986542
Perit Dial Int. 1997 Jul-Aug;17(4):360-4
9284463
Am J Kidney Dis. 2009 Feb;53(2):290-7
18805609
J Am Soc Nephrol. 1996 Oct;7(10):2176-82
8915978
J Am Soc Nephrol. 1998 Oct;9(10):1956-64
9773798
Kidney Int Suppl. 2006 Nov;(103):S44-54
17080111
J Am Soc Nephrol. 1996 Feb;7(2):198-207
8785388
J Clin Nurs. 2015 Jan;24(1-2):222-34
25256788
Am J Kidney Dis. 2004 Jan;43(1):103-11
14712433