In-Center Hemodialysis Experiences Among Latinx Adults: A Qualitative Study

IF 3.2 Q1 UROLOGY & NEPHROLOGY
Katherine Rizzolo , Colin Gardner , Claudia Camacho , Rebeca Gonzalez Jauregui , Sushrut S. Waikar , Michel Chonchol , Lilia Cervantes
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Abstract

Rationale & Objective

Latinx individuals are more likely to start and remain receiving in-center hemodialysis, over home dialysis, than non-Latinx White individuals. The objective of our study was to understand the drivers of sustained in-center dialysis and deterrents of switching to home dialysis use for Latinx individuals receiving in-center dialysis.

Study Design

This qualitative study used semistructured one-on-one interviews.

Setting and Participants

Latinx adults receiving in-center hemodialysis therapy at 2 urban dialysis clinics in Denver, Colorado between November 2021 and March 2023.

Exposures

In-center hemodialysis, Latinx ethnicity.

Outcomes

Qualitative.

Analytical Approach

Interviews were analyzed with thematic analysis using inductive coding. Theoretical framework development used principles of grounded theory.

Results

In total, 25 Latinx adults (10 [40%] female and 15 [60%] male) receiving in-center hemodialysis therapy participated. One theme demonstrated that Latinx individuals experienced hardship with in-center dialysis but used Latinx values to persevere: Psychosocial resilience using Latinx cultural values (faith and spiritual coping, belief in predestination and acceptance, optimism and positive attitude toward treatment, and positive relationships with health care professionals and peers). Two themes illustrate barriers to starting or switching to home dialysis: Insufficient knowledge of kidney replacement therapy (lack of awareness of kidney disease, lack of preparation for dialysis) and Barriers to patient-centered decision making in dialysis treatment (lack of peer perspective to guide dialysis decision making, fear and apprehension of home dialysis, lack of socioemotional support, perception of housing issues).

Limitations

Most participants were from the same geographic area and country of origin, and some may have been uninsured because of immigration status.

Conclusions

As Latinx people are less likely to be treated with home dialysis modalities, this study offers important context as to what factors drove sustained in-center dialysis use for this population. Coping mechanisms that promoted resilience with in-center dialysis treatment motivated individuals to remain on in-center hemodialysis, and positive dialysis relationships in the dialysis center strengthened this experience. Switching to home dialysis is hindered by lack of knowledge as well as lack of patient-centered dialysis decision making. Understanding the drivers of sustained in-center hemodialysis use for Latinx individuals is important for future efforts at improving patient-centered education, framing conversations around modality choice, and care for this population.

Plain-Language Summary

Latinx individuals are more likely to receive in-center hemodialysis over home dialysis (peritoneal and home hemodialysis) compared with non-Latinx White individuals. This study interviewed Latinx individuals undergoing in-center hemodialysis in Denver, Colorado. Coping mechanisms driving by a cultural belief system of faith, fatalism, and optimism encouraged staying on in-center hemodialysis, and patients enjoyed the social element of hemodialysis. We found lack of awareness and preparation for kidney disease influenced starting and remaining on in-center dialysis. Switching to home dialysis was hindered by a fear, as well as lack of support and housing issues. Understanding these factors is crucial for improving education and conversations about dialysis options for Latinx individuals, particularly those already receiving in-center dialysis.
拉丁裔成年人的中心内血液透析经历:定性研究
理论依据& 目标与非拉丁裔白人相比,拉丁裔人群更有可能开始并继续接受中心内血液透析,而不是家庭透析。我们的研究旨在了解拉美裔接受中心内透析者持续接受中心内透析的驱动因素以及转为家庭透析的阻碍因素。环境和参与者2021 年 11 月至 2023 年 3 月期间,在科罗拉多州丹佛市的 2 家城市透析诊所接受中心内血液透析治疗的拉美裔成年人.暴露中心内血液透析、拉美裔.结果定性.分析方法采用归纳编码法对访谈进行主题分析。结果共有 25 名接受中心血液透析治疗的拉美裔成年人(10 名[40%]女性和 15 名[60%]男性)参加了访谈。其中一个主题表明,拉丁裔个体在中心内透析过程中经历了艰辛,但他们利用拉丁裔价值观坚持了下来:利用拉丁裔文化价值观(信仰和精神应对、相信宿命和接受、乐观和积极的治疗态度,以及与医护人员和同龄人的积极关系)进行心理社会复原。两个主题说明了开始或改用家庭透析的障碍:对肾脏替代疗法的认识不足(缺乏对肾脏疾病的认识、缺乏透析前的准备)和透析治疗中以患者为中心的决策障碍(缺乏同伴观点来指导透析决策、对家庭透析的恐惧和忧虑、缺乏社会情感支持、对住房问题的看法)。局限性大多数参与者来自同一地理区域和原籍国,有些人可能因为移民身份而没有保险。促进中心内透析治疗适应性的应对机制促使患者继续接受中心内血液透析,而透析中心内积极的透析关系则加强了这种体验。由于缺乏相关知识以及缺乏以患者为中心的透析决策,转为家庭透析受到了阻碍。了解拉美裔患者持续使用中心内血液透析的驱动因素,对今后改善以患者为中心的教育、围绕透析方式选择的对话框架以及对该人群的护理具有重要意义。本研究采访了在科罗拉多州丹佛市接受中心内血液透析的拉丁裔患者。由信仰、宿命论和乐观主义等文化信仰体系驱动的应对机制鼓励患者继续接受中心内血液透析,而且患者喜欢血液透析中的社交元素。我们发现,缺乏对肾病的认识和准备影响了患者开始和继续接受中心内透析。转为家庭透析则受到恐惧、缺乏支持和住房问题的阻碍。了解这些因素对于改善针对拉美裔人群,尤其是已经接受中心内透析的人群的透析选择教育和对话至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
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