A Mixed Methods Study of Symptom Experience in Patients With End-Stage Renal Disease

Abstract

Background Patients with end-stage renal disease receiving dialysis experience a significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients’ experiences is lacking. Objectives The aim of this study was to explore factors that are associated with patients’ symptom experiences. Methods The convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 participants to examine its associations with patient characteristics using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by 10 participants were identified through semistructured interviews using content analysis. Assessments were conducted at enrollment, 6 months, and 12 months. After separate data analyses, findings were integrated using side-by-side comparison and joint display. Results Several significant associations were identified between patient characteristics and symptom burden, and the participants described four categories of factors (i.e., treatment related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Participants described several factors not reported previously. Discussion This study explored subjective and objective factors influencing the symptom experiences of patients with end-stage renal disease using a mixed methods design. These risk factors can be used to identify high-risk patients. Our findings suggest that participants relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that assessment of both subjective and objective factors is needed to explore patients’ symptom experiences.

Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review

“…The sample sizes ranged from 58 [ 44 ] to 28,561 [ 67 ]. While most of the studies only included patients on hemodialysis, in seven studies [ 29 , 31 , 32 , 48 , 68 , 69 , 70 ], 21.1% to 100% of the patients received peritoneal dialysis. Patients were predominantly male and had a mean age of 46.1 to 68.7 years.…”

“…While most studies used a cross-sectional design, seven were longitudinal studies with a follow-up period from 1 to 15 years [ 38 , 45 , 48 , 67 , 69 , 71 , 72 ]. Six studies evaluated the association between financial hardship and overall symptom burden.…”

“…One study found that income level indirectly affected symptom distress via the mediation of social support ( p < 0.05) [ 27 ]. In one longitudinal study, a higher monthly income (i.e., >HK$20,000) was associated with a lower DSI score ( p < 0.02) [ 69 ]. However, this association was not consistent over time.…”

Challenges encountered by patients with end‐stage kidney disease in accessing symptom management services: A narrative inquiry

“…The study participants were recruited from the sample of a quantitative survey in a mixed‐methods project about their symptom experiences (Ng, Wong, Choi, et al., 2020). Eligible participants were adults with diagnosed ESKD who had received dialysis treatment for three consecutive months at the study sites (i.e., two regional hospitals in Hong Kong).…”

“…This study aimed to use a narrative inquiry approach to understand the storied experiences of patients receiving maintenance dialysis for ESKD with respect to symptom management services. It is part of a mixed‐methods doctoral thesis (Ng, Wong, Choi, et al., 2020).…”