Understanding the impact of haemodialysis on UK NHS patients’ wellbeing: a qualitative investigation

Aims and Objectives: While haemodialysis (HD) is an effective treatment for end-stage renal disease (ESRD), the requirements and restrictions it imposes on patients can be onerous. The aim of the current study was to obtain UK National Health Service (NHS) patients’ perspectives on the challenges arising from HD with the intention of identifying potential improvements. Background: Depression rates are particularly high in those with ESRD, however, there is limited insight into the range of stressors associated with HD treatment within the NHS contributing to such high rates, particularly those of a cognitive or psychological nature. Design: A qualitative approach was used to obtain rich, patient-focused data; one-to-one semi-structured interviews were conducted with twenty ESRD at a UK NHS-centre. Methods: Patients were interviewed during a typical HD session. Thematic analysis was used to systematically interpret the data. Codes were created in an inductive and cyclical process using a constant comparative approach. Results: Three themes emerged from the data: 1) fluctuations in cognitive/physical wellbeing across the HD cycle, 2) restrictions arising from the HD treatment schedule, 3) Emotional impact of HD on the self and others. The findings are limited to predominantly white, older patients (median = 74 years) within an NHS setting. Conclusions: Several of the experiences reported by patients as challenging and distressing have so far been overlooked in the literature. A holistic-based approach to treatment, acknowledging all aspects of a patient’s wellbeing, is essential if optimal quality of life is to be achieved by healthcare providers. Relevance to clinical practice: The findings can be used to inform future interventions and guidelines aimed at improving patients’ treatment adherence and outcomes, for example, improved reliable access to mental health specialists