Lived Experiences of Patients Receiving Hemodialysis during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network

Abstract

Background: Hemodialysis patients have faced unique challenges during the COVID-19 pandemic. They face high risk of death if infected, and have unavoidable exposure to others when they come to hospital three times weekly for their life-saving treatments. The objective of this study was to gain a better understanding of the scope and magnitude of the impacts of the pandemic on the lived experience of patients receiving in-center hemodialysis. Methods: We conducted semi-structured interviews with 22 patients who were undergoing dialysis treatments in five hemodialysis centers in Montreal from Nov 2020 to May 2021. Interviews were transcribed and then analyzed using thematic content analysis. Results: Most participants reported no negative impacts of the COVID-19 pandemic on their hemodialysis care. Several patients had negative feelings related to forced changes in their dialysis schedules, and this was especially pronounced for indigenous patients in a shared living situation. Some patients were concerned about contracting COVID-19, especially during public transportation, while others expressed confidence that the physical distancing and screening measures implemented at the hospital would protect them and their loved ones. Some participants reported that masks negatively impacted their interactions with healthcare workers, and for many others, the pandemic was associated with feelings of loneliness. Finally, some respondents reported some positive impacts of the pandemic, including use of telemedicine, and creating a sense of solidarity. Conclusion: Patients undergoing hemodialysis reported no negative impacts on their medical care, but faced significant disruptions in their routines and social interactions due to the COVID-19 pandemic. Nevertheless, they showed great resilience in their ability to adapt to the new reality of their hemodialysis treatments. We also show that studies focused on understanding the lived experiences of indigenous patients and patients from different ethnic backgrounds are needed in order reduce inequities in care during public health emergencies.

Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis

“…During the months of May and June 2020, all-cause mortality was 26% higher than that during 2017-2019. The higher mortality during the early pandemic months is likely due to missed dialysis treatments [22][23][24][25][26]. Thus, the more modest increase in mortality in Veteran patients receiving maintenance hemodialysis in the VA is likely due to lack of disruption in the delivery and receipt of dialysis treatments which involve both patient and systemrelated factors.…”

Pengalaman Pasien Hemodialisis yang Sudah Sembuh dari COVID-19

“…Menariknya, pasien yang menjalani hemodialisis paling lama paling tidak terpengaruh oleh perubahan akibat pandemi. Pasien hemodialisis menunjukkan ketahanan yang luar biasa, dan mungkin lebih banyak waktu yang dihabiskan dalam hemodialisis meningkatkan ketahanan ini (Malo et al, 2022).…”

Lived Experiences of Hemodialysis Health Care Workers during the COVID-19 Pandemic: A Qualitative Study from the Quebec Renal Network

“…Our study of hemodialysis patients also found that masks interfered with their communication with HCWs, since they were unable to see HCWs' facial expressions. 14 In a recent systematic review of studies looking at physician and patient communication during the COVID-19 pandemic, protective equipment as a barrier to verbal and nonverbal expression was the most important theme under the topic of reduced communication. 23 Masks could also prevent patients from visually recognizing their HCWs.…”

“…5,9 Since the beginning of the COVID-19 pandemic, HCWs, including dialysis staff, have been at risk of increased psychological stress and distress given their exposure to death, lack of appropriate equipment, moral injury, increased workload, and the risks of COVID-19 infection. 10,11 The objective of our study, which is part of a larger study documenting the impact of COVID-19 on hemodialysis clinics in Quebec, [12][13][14] was to gather HCWs' experiences and perspectives of providing care during the first wave of the COVID-19 pandemic. A better understanding of the scope and magnitude of the challenges faced by hemodialysis staff during the pandemic would help to inform interventions during future public health emergencies and could also provide strategies to mitigate stress for dialysis staff and improve care for patients.…”