The Meaning of Life Story Card for People Undergoing Hemodialysis

Abstract

Purpose

Patients undergoing hemodialysis often experience various forms of psychological distress. The Life Story Card (LSC) intervention is designed to provide psychological support by encouraging patients to share their personal narratives, which are then compiled into concise cards. This study aimed to explore the meaning of the LSC intervention for patients undergoing hemodialysis.

Patients and Methods

Twenty-one patients undergoing hemodialysis at a hospital were recruited. Data were collected through distribution of LSCs that summarized participants’ narratives and through interviews exploring their impressions of the intervention. The data were analyzed using reflexive thematic analysis.

Results

Three themes emerged regarding the meaning of the LSC: “transforming narratives into tangible memories”, “satisfaction in communicating my thoughts”, and “gained courage to live”..

Conclusion

Although LSC interventions have primarily been used with patients with dementia, the results of this study suggest that they may also serve as a practical communication tool for hemodialysis patients facing various challenges. Furthermore, simplified LSCs, such as single cards that can be created quickly without preparing an entire booklet, were well-received by participants.

Plain Language Summary

People receiving hemodialysis often experience emotional challenges such as anxiety, stress, and low mood. However, there are few simple and practical methods to support their psychological well-being in routine healthcare settings. This study explored what the Life Story Card (LSC) intervention meant to people receiving hemodialysis. The LSC is a brief activity in which patients share important parts of their life story, which are then summarized on a small, easy-to-read card. A total of 21 people receiving hemodialysis participated in the study. After creating their LSCs, participants were interviewed about how the experience affected them. Many participants described positive changes. Some reported feeling pleased to see their life experiences clearly organized, which helped them reflect on their lives. Others appreciated the opportunity to share their thoughts and experiences about their illness and treatment. Many also reported gaining a sense of courage and motivation to continue their lives. These findings suggest that participants perceived even a simple tool such as an LSC to be a meaningful source of emotional support. Because it is quick and easy to use, the LSC could be incorporated into healthcare settings. Overall, this study suggests that the LSC may be a practical way to support the emotional well-being of individuals receiving hemodialysis.

Graphical Abstract

Introduction

Kidney diseases, including chronic kidney disease (CKD), acute kidney injury (AKI), and kidney failure requiring renal replacement therapy, affect an estimated 850 million people worldwide, and this number continues to rise.¹ CKD, in particular, adversely affects both physical and psychological health and is often accompanied by symptoms such as depression, anxiety, and uncertainty about the future.² By the end of 2023, the number of patients undergoing chronic dialysis in Japan had reached 343,508, of whom approximately 97.0% were receiving hemodialysis.³

Before CKD progresses to the point of requiring dialysis, patients must engage in self-care practices, such as dietary management, and receive medical treatment, including blood pressure and blood glucose control. However, once renal function is severely impaired, recovery is generally impossible, and patients require lifelong dialysis to sustain life. This lifelong dependence can place considerable psychological burden on patients, making them more vulnerable to feelings of helplessness, depression, and fear.⁴ Ng et al reported that 25% to 41% of patients with CKD experience psychological distress, which may contribute to mental health problems.⁵ These findings highlight the importance of providing effective psychological support for patients undergoing long-term hemodialysis.

Life Story Books (LSBs) are personalized compilations of an individual’s life experiences and memories, often incorporating photographs and written narratives to support communication and person-centered care.⁶ LSBs have been used in dementia care to support psychological well-being. Through LSBs, patients and their families reflect on personal histories, compile meaningful information, and incorporate these insights into care.⁷ Previous studies have demonstrated that LSB interventions can improve psychological outcomes in patients with dementia, including self-integration, quality of life, well-being, self-esteem,⁸ reduced depression, improved mood,⁹ increased self-worth, and reduced anxiety.¹⁰ Patients undergoing hemodialysis also experience considerable psychological challenges and may benefit from interventions that promote self-reflection, communication, and emotional support. These findings suggest that similar approaches may benefit patients undergoing hemodialysis.

However, our literature review identified no studies that examined the use of LSB interventions to address psychological problems in patients undergoing hemodialysis, including those using terms such as “life story”, “life story work”, or “memory album”.¹¹ Similarly, a review of previous literature on psychosocial interventions for dialysis patients revealed no studies on narrative interventions or reminiscence therapy specifically tailored for individuals with kidney failure.

Despite their benefits, LSBs are time-intensive, as they require detailed narrative collection and compilation into a bound format, which limits their feasibility in busy clinical settings. To address this limitation, the authors developed the Life Story Card (LSC), a simplified alternative in which patients’ narratives are summarized on a single card. To date, no studies have examined the impact of LSB or LSC interventions on patients undergoing hemodialysis. Dignity therapy is structured to elicit reflections on living with a long-term, treatment-dependent condition, and therefore shares similarities with the content of the LSC intervention. Regarding dignity therapy for hemodialysis patients, Chen et al¹² conducted a randomized controlled trial and demonstrated that dignity therapy significantly reduced overall dignity-related distress. However, all interventions were delivered by trained research staff who completed a one-month dignity therapy training program, indicating that specialized training is required.

If this study clarifies the significance of the LSC for dialysis patients, it may demonstrate the potential of the LSC as a support tool that nurses can use in busy clinical settings without requiring extensive specialized training. Therefore, this study aimed to examine the meaning of the LSC intervention for this population.

This study examines the significance of LSC interventions for hemodialysis patients based on qualitative accounts of their experiences and perceptions. The remainder of the manuscript is organized as follows: the next section describes the study methods, followed by the results, discussion, and conclusions.

Methods

Study Design

This qualitative study employed in-depth interviews to explore the impact of the intervention. The research design was informed by Wills and Day and by Wilson et al^6,13 The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ), and these guidelines were followed throughout the study design, data collection, and reporting phases.¹⁴

Participants

Participants were recruited from patients undergoing hemodialysis at a hospital in Gunma Prefecture, Japan. Recruitment posters were displayed at the hospital, and individuals who expressed interest were enrolled. In addition, some participants were recruited through direct invitations from hospital administrators. The hospital administrator made only one direct inquiry to each patient. During this approach, the clinical staff directly responsible for the patient’s care were not involved. Furthermore, the study was explained by someone from outside the hospital, and written informed consent was also obtained by an external individual. These measures were implemented to minimize any perceived pressure on patients to participate in the research. Consistent with Braun and Clarke,¹⁵ who recommend a sample size of 20 or more for large-scale qualitative studies, a minimum of 20 participants were targeted for this study. The eligibility criteria were as follows:

• (1)Ability to understand the study’s content, significance, and purpose and to provide informed consent;
• (2)Age 20 years or older; and
• (3)Ability to participate in interviews conducted in Japanese and to read and review LSCs written in Japanese.

The exclusion criteria were an inability to speak or read Japanese and the presence of visual impairment.

Twenty-two patients undergoing hemodialysis were invited to participate; one declined due to family opposition. The final sample comprised 21 participants, all of whom completed the study. The mean duration of dialysis was 7 years and 0 months. The participants’ mean age was 67.3 years; 13 were men and 8 were women. Of the participants, five had diabetic nephropathy, one had chronic glomerulonephritis, one had IgA nephropathy, one had AKI, and 13 had CKD of unknown cause (Table 1).

Table 1.

Characteristics of the Study Participants

Characteristic	Category	Participants (N = 21), n (%) or Mean
Age (years)	Mean	67.1
Sex	Male	13 (62)
	Female	8 (38)
Primary kidney disease	Chronic kidney disease of unknown cause	13 (62)
	Diabetic nephropathy	5 (23)
	IgA nephropathy	1 (5)
	Acute kidney injury	1 (5)
	Chronic glomerulonephritis	1 (5)
Duration of dialysis	Mean	7 years and 6 months

Notes: Data are presented as n (%) unless otherwise indicated.

Procedures

Procedures for Creating a Life Story Card (Figure 1)

Figure 1.

Procedure for creating the Life Story Card (LSC) and conducting the study interviews.

To create the LSC, participants were invited to discuss their experiences and thoughts regarding dialysis and living with the condition. The interviewer asked questions such as “How did you feel about starting dialysis?” and “What is important to you in your life?” All participants were interviewed once in person by MO and YI, or by MO along with a fourth-year university student.

The interviewers introduced themselves to participants both verbally and in writing. Participants were informed that MO and YI had experience in dialysis nursing and that the student interviewer had received training in a dialysis unit. The purpose of the study was also explained verbally and in writing. Interviews were conducted at participants’ bedsides during dialysis sessions, in accordance with their preferences. Although other patients were present in the same unit, the beds were sufficiently separated to ensure that conversations could not be overheard. While no standardized template was prepared for creating the LSCs, nurses referenced previously completed cards by their colleagues as guides. In addition, the interviews for LSC creation typically took approximately 60 to 90 minutes.

Audio-recorded interviews were transcribed verbatim. In creating these transcripts, we focused on capturing segments in which participants expressed their emotions and feelings, rather than only describing events. From these transcripts, researchers identified key aspects of what participants valued and their significant life experiences, which were then summarized on the LSC. The card was created by folding a sheet of plain, thick paper (approximately 30 cm × 20 cm) in half. It included a photograph or illustration of an object meaningful to the participant, as well as a personalized message from a nurse at the kidney center who regularly provided their care. The nurses’ messages consisted of one or two lines of comments written on cards based on the participants’ LSC drafts.

Drafts of the cards were always reviewed by the storytellers themselves, who were asked to check for any errors in proper nouns or content and to identify any sections that should be deleted. The interviewer drafted the wording and prepared the images, but the narrator ultimately made the final decision.

The message was based on each participant’s narrative. Completed LSCs were given to the participants and read aloud to them.

Data Collection

In-depth interviews were conducted by the three interviewers involved in LSC development. These interviews focused on participants’ impressions and emotional responses after reading their LSCs. Participants were informed of the interview topic in advance to allow time for reflection. Although a semi-structured approach was used, interview questions were adapted as needed to encourage deeper exploration of participants’ perspectives.

Interviews were audio-recorded and accompanied by field notes. Because participants’ narratives were incorporated into the LSCs, participants were asked to review the content during the drafting stage to ensure accuracy, including the spelling of proper nouns. Each participant was interviewed once after reading the LSC and, if they requested revisions, a second time. Thus, each participant completed up to two interviews.

Each interview lasted approximately 50–90 minutes, with exact durations varying due to interruptions for routine clinical procedures (eg, blood pressure measurements).

Data Analysis

Data were analyzed using reflexive thematic analysis (RTA), as described by Braun and Clarke and Braun et al.^15,16 RTA is well suited to identifying patterns of meaning across qualitative data and was therefore appropriate for examining common meanings following the LSC intervention.

In accordance with the interpretive nature of RTA,¹⁷ particularly the epistemological assumptions underpinning the analysis, the analysis followed a six-phase process.¹⁷ Microsoft Word and Excel were used for data management. In phase one, the researchers familiarized themselves with the data: the interviews were transcribed verbatim, all transcripts were read several times, and familiarity with the content was developed with the research questions in mind. In phase two, relevant parts of the data in relation to the research questions were identified, and concise code labels were created through open coding. An inductive approach, focused on both the semantic and latent features of the data, was adopted. In phase three, an initial hierarchical theme was developed by grouping codes that appeared to share core ideas and concepts into clusters and developing these into subthemes, modifying the codes as necessary. In phase four, the codes and subthemes were reviewed and developed into tentative themes through repeated revisions. Returning to the entire dataset, we identified patterns corresponding to the research questions. During theme analysis, when there were differences in interpretation or disagreements of opinion, we repeatedly returned to the original data for further review. In phase five, the final themes were determined, and both authors reviewed the consistency of the themes and their relevance to the research questions, agreeing on the thematic structure. The final themes were reported orally to participants whom we were able to meet, and both authors confirmed the truthfulness and understanding of the themes based on participants’ responses. The report was prepared in phase six.

Data analysis was conducted in Japanese, and the results were translated into English by the researchers, after which professional English editing was performed by a specialized editing service. The edited English results were then presented again in Japanese while preserving the nuances of the English version, and the final themes were subsequently determined.

Researcher Reflexivity

Our professional backgrounds have provided us with valuable contextual understanding of dialysis care and the patient experience. At the same time, however, we were seeking effective nursing support for the psychological aspects of living with dialysis and wanted to ensure that we did not overlook any changes in patients’ responses to nursing interventions.

To enhance reflexivity, MO and HJ engaged in ongoing discussions throughout the analytic process, critically examining how their clinical experiences and prior knowledge might influence interpretation. They maintained reflexive awareness of their assumptions during coding and theme development and actively attended to data that challenged their initial interpretations. Themes were developed through iterative dialogue and repeated review of the original transcripts to ensure that interpretations remained grounded in participants’ accounts rather than primarily reflecting the researchers’ professional perspectives.

The interviewers were not involved in the participants’ direct clinical care, which helped to reduce potential power imbalances and encouraged participants to speak openly about their experiences.

Results

Generated Themes

Analysis of the participants’ narratives yielded 315 codes, from which three themes and seven subthemes were derived. The three themes were “transforming narratives into tangible memories”, “satisfaction in communicating my thoughts”, and “gained courage to live”.

Theme 1: “Transforming Narratives into Tangible Memories”

This theme describes how the narrative of one’s life does not remain a temporary statement but instead results in a tangible object that participants are pleased to hold in their hands—a card with a binding that represents themselves. This theme comprises two subthemes:

Subtheme 1: “Recognizing Oneself in the Card”

This subtheme reflected participants’ appreciation when the color of the card matched their favorite color or when it included a photograph or illustration of an object they cherished. For instance, Participant J enjoyed vegetable gardening; therefore, the card contained an illustration of a man smiling while holding harvested vegetables. The following narrative was obtained from Participant J:

(Participant J) Seeing a picture of vegetables on the card feels special to me. Since I put so much effort into growing vegetables, it makes me think, “Oh, this really connects to my passion for farming”.

Participant J picked up the card, gazed intently at the illustration of “Mr. J” on it, and, nodding repeatedly, expressed the impressions described above.

Subtheme 2: “It’s Better to Be a Thing Than Just a Word”

This subtheme suggests that patients consider it beneficial for nurses not only to listen to their narratives but also to preserve them in the form of cards. For instance, Participant I learned to cook specifically for weight control after starting dialysis. He was praised by a hospital nurse and recounted this experience during our interviews. Accordingly, a card was created describing Participant I’s efforts to “learn to cook for weight management”. Consequently, the following narratives were obtained, and participants described the satisfaction of having their narratives transformed into “objects” that could be decorated, rather than remaining only as words:

(Participant I) Whatever it is, it’s different when it’s in one form rather than another. It is in your mind at the time, but it usually goes away. So if you keep it as an object, especially if you display it, you can remember it when you see it from time to time.

Participants noted that the stories are transient, whereas the cards remain as physical objects that can be revisited repeatedly.

Theme 2: “Satisfaction in Communicating My Thoughts”

This theme expresses a desire for others, including healthcare professionals and family members, to communicate with participants and to understand their thoughts and feelings about living with the disease and undergoing dialysis. It comprised two subthemes: feelings toward the facility and healthcare professionals, and feelings toward the family, indicating that participants derived satisfaction from being able to disclose their actions and feelings.

Subtheme 1: “The Happiness of Being Able to Communicate My Thoughts and Needs to the Facility and Healthcare Professionals”

This theme describes the joy participants experienced when they were able to communicate their thoughts and requests to the facility and healthcare professionals, something they had previously been unable to express verbally. For instance, Participant B stated the following:

(Participant B) I value what I can do independently at this stage of my life and want to spend time talking with my family until my final days. I have always wanted to express my wishes regarding hospitalization and dialysis treatment. However, I found it difficult to communicate these wishes to the hospital. The cards became a helpful tool for conveying my thoughts. I am most grateful that I was able to share my requests with the hospital staff, and that they considered them thoughtfully.

Participant B’s interviewer noted the following on his card: “I keep reflecting on my role as a family member”. Participant B also told the nurse that he had shown the LSC prepared by the nurse to his wife and daughter, saying,

This card contains what I have been thinking all along about the two of you. I could not bring myself to say it before, but if I can no longer communicate with you, there is no point in continuing hemodialysis. You are my whole life.

Subtheme 2: “Happiness of Being Able to Tell My Family and Acquaintances About My Hard Work and Thoughts”

This indicates that participants were pleased to share their thoughts and efforts with their families and friends through the LSC. For example, Participant I stated:

(Participant I) Through the cards, I was able to convey to my family what I usually think. My wife showed the cards to her daughter and grandchildren, and they responded well. When I showed it to my grandchildren again, saying that grandpa is doing his best, they said it was great (and praised me).

Participant I’s card stated: “I will never give up. I came when I could. That’s why I’m happiest now”.

Theme 3: “Gained Courage to Live”

This theme describes how reading the cards enabled participants to feel supported by those around them and how reflecting on their past selves made self-acceptance and hope for the future possible. It was developed from three subthemes: “Reading the cards shows support from the people around me”, “Satisfaction with past self-management”, and “The card gives me hope for the future”.

Subtheme 1: “Reading the Cards Shows Support from the People Around Me”

Some cards also contained messages of encouragement from nurses and students who had heard the narrators’ stories. Participants reported that, by looking at these cards, they could tell that the nurses were cheering them on. For instance, the narratives of Participants K and B were as follows:

(Participant K) If I don’t come to the hospital, my life will end. And the card shows that the nurses at the hospital are cooperating with me.

(Participant B) Even when I feel down, the card encourages me because I know that the students are cheering me on, the nurses are cheering me on, and the teachers are cheering me on.

Therefore, it was clear that including supportive messages on the cards encouraged the participants.

Subtheme 2: “Recognizing My Past Efforts”

During the LSC intervention, participants were asked to talk about their past. Because all participants in this study were patients undergoing hemodialysis, they often spoke about the self-care they had previously carried out and their past satisfaction with these practices.

(Participant L) I was doing what I could do (diet control, exercise, etc.) in my own way. But there are some things I am ashamed of. I don’t get compliments very often, so I feel embarrassed. I don’t usually talk about myself. As I don’t usually talk about myself, I was happy to talk about my past self-management in the LSC interview.

As described above, although they did not usually talk about themselves, reflecting on their past self-care through the LSC enabled participants to describe feeling both embarrassed and satisfied with themselves.

Subtheme 3: “The Card Gives Me Hope for the Future”

It was evident that viewing their cards motivated the participants to continue working hard and gave them hope for the future.

(Participant A) I think that by looking at the cards, I feel motivated to do my best.

(Participant D) It’s hard to talk about yourself without a chance. Talking about myself gave me a chance to think about doing my best again. I think it will help me to think in a good direction.

Participant A described her willingness to continue working hard, and Participant D discussed the possibility that talking about herself might help her think more positively about her future.

Discussion

This study drew on data from 21 participants. Although all participants were outpatients at a single facility, their age, gender, and underlying conditions were representative of the general demographic profile of dialysis patients in Japan as a whole. Furthermore, given that the interviews lasted between 50 and 90 minutes, which we considered sufficient to obtain rich data, and that an adequate number of codes were generated, we believe that a sample size of 21 participants was appropriate.

This study was conducted to examine the impact of the LSC intervention on patients undergoing hemodialysis. Three themes emerged. First, the theme “transforming narratives into tangible memories” was identified. Participants visually confirmed aspects that represented them by including photographs of objects that were meaningful to them and inserting these images into the cards.

It has been estimated that approximately 90% of external information obtained from the external environment is acquired through sight and hearing, with vision accounting for about 80%, making it the dominant sensory modality.¹⁸ Accordingly, gaining a visual understanding of one’s narrative, as facilitated by the LSC, may provide participants with more information about themselves than narration alone. By visually identifying the objects and events that represented themselves, participants may have felt as if they were seeing their representation, which may not always be pleasant. However, because the LSC used in this study focused on what participants regarded as enjoyable and as achievements they had worked hard to attain, they were happy to see their lives take shape. Through the LSC, they may have been able to deepen their understanding of what they enjoyed by obtaining information about their own lives.

Participants thought it would be beneficial for nurses not only to listen to their narratives, but also to preserve them in the form of tangible objects. Such objects can be displayed at home, as described by Participant I. Several participants mentioned that they kept the LSCs given to them by their nurses and looked at them from time to time. In this way, participants recognized the value of keeping the LSC as a physical object that could be repeatedly viewed. Listening to patients is fundamental to nursing and is consistently regarded as important. However, in addition to listening, preparing written records of what was heard may have had the effect of visually demonstrating the participant’s identity. The LSC may therefore serve as an effective communication tool between patients and healthcare professionals.

The second theme, “satisfaction in communicating my thoughts”, comprised two subthemes. The first subtheme concerned the impact of being able to communicate professional content about medical care related to disease management and treatment. Contact time between nephrologists and patients is limited both in the United States and internationally, and healthcare providers worldwide may not spend sufficient time talking with patients.¹⁹ Patients undergoing hemodialysis who are less satisfied with their nephrologists have been reported to show poorer treatment compliance. Physician support for patients has also been reported to improve patient survival.¹⁹ Thus, support from healthcare providers for patients undergoing hemodialysis also affects patient prognosis. To create an LSC, nurses must spend at least 30 minutes talking with their patients. Participant B was satisfied that, by using the LSC, he was able to communicate his wishes regarding his final days to healthcare professionals. While the LSC alone cannot lead to improved survival rates, the fact that nurses set aside time to listen to patients may encourage patients to express their thoughts and needs.

For patients undergoing hemodialysis, social support from family members has the greatest impact on hemodialysis adjustment.²⁰ Communicating the patient’s thoughts and feelings to important family members through the LSC may improve patient well-being. For instance, by presenting Participant I’s efforts and thoughts while undergoing painful dialysis treatment on the card, he was able to express gratitude to his family, which he normally could not express. This may have led to her statement, “I am the happiest now!”

The third theme, “Gained courage to live”, consisted of three subthemes. This theme suggests that feeling supported by others and reflecting positively on one’s past self through reading the cards contributed to self-acceptance and hope for the future.

The first subtheme indicates that the patients’ cards conveyed a sense of support from those around them. Our analysis suggests that the LSC is an effective intervention for patients undergoing hemodialysis, as the messages from healthcare providers helped them feel supported.

Participants also reflected on their past self-care practices, which contributed to a sense of pride and satisfaction with their improved ability to care for themselves and to overcome food cravings through the LSC. Self-care is important for patients undergoing hemodialysis, as it influences whether they experience a stable dialysis journey or develop long-term complications.²¹ Patients also struggle to refrain from consuming their favorite foods and beverages as part of improving their self-care. In the LSC, patients often recount events that left a deep impression, which they have written down and will keep with them. They emphasized that self-care is important and expressed pride in being able to share these memorable experiences. Thus, the LSC could have been helpful for patients by increasing their satisfaction with their self-care.

Additionally, the LSC instills hope for the future. After receiving the cards, participants described an increased willingness to continue dialysis and reported that the LSC helped them think more positively about their future. In the LSC, we ask people to tell us about themselves, which is a form of self-disclosure. Jourard and Lasakow defined “self-disclosure as the process of sharing inner thoughts or confusions with a target person”.²² Therefore, when patients engage in self-disclosure, they share their thoughts and confusions with others, which helps them avoid suffering alone. Self-disclosure among patients with cancer has been reported to effectively improve their quality of life.²³ It has also been found to help patients cope better with their illnesses by enhancing their self-awareness and keeping them aware of what they have learned.²⁴

Self-disclosure by dialysis patients is considered one of the factors characterizing a favorable psychological profile.²⁵ Therefore, telling their stories and engaging in self-disclosure when creating LSCs motivated the participants to cope better with dialysis. The theme “gained courage to live” was generated because the LSC helped participants feel supported by those around them, and self-disclosure enabled them to escape from suffering alone and to have hope for the future. Thus, the LSC intervention may be a feasible narrative tool for supporting communication and emotional reflection in hemodialysis care.

Limitations

This study has several limitations. First, the sample size was small, and all 21 participants were recruited from a single facility, raising the possibility of selection bias and limiting the generalizability of the findings. Furthermore, although the intervention was conducted by the researchers and neither the administrators nor facility nurses were involved in data collection, the possibility of perceived coercion during recruitment cannot be excluded because facility administrators approached potential participants.

Second, because the LSCs were created by nurses, social desirability bias may have influenced participants’ responses, with participants potentially wishing to present themselves as “good patients” who express gratitude. Additionally, participants’ statements may have been influenced by cultural and contextual factors specific to hemodialysis care in Japan, such as long-term relationships with healthcare providers and a tendency to hesitate to express their genuine feelings.

A key challenge for future research is to collect data from facilities with more diverse backgrounds. Although these findings are based on a single interview conducted after the LSC intervention, dialysis patients encounter a range of challenges throughout their lives and continue to undergo treatment. Moving forward, further implementation and evaluation of the LSC intervention, together with longitudinal follow-up, will be important to provide support tailored to the psychological and social changes experienced by participants.

Furthermore, although qualitative findings suggest that the LSC is a promising intervention, further research is needed to develop standardized protocols and to evaluate its effectiveness through randomized controlled trials and longitudinal studies in order to establish robust evidence of its psychological benefits.

Conclusion

This study identified three key meanings of the LSC intervention for patients undergoing hemodialysis: “transforming narratives into tangible memories”, “satisfaction in communicating my thoughts”, and “gained courage to live”.

Importantly, participants responded positively to brief, easily created Life Story Cards positively, suggesting that they may represent a feasible narrative tool for promoting communication and emotional reflection in hemodialysis care.

Funding Statement

This work was supported by JSPS KAKENHI (Grant Number JP26K13514), a major competitive funding program in Japan that supports a broad spectrum of academic research based on researchers’ independent ideas.

Ethical Considerations

This study was reviewed and approved by the Gunma University Ethics Review Committee for Medical Research Involving Human Subjects (Study No. 2017-064) and conducted in accordance with the ethical principles of the Declaration of Helsinki. Each participant received both written and oral explanations of the study’s purpose, procedures, and ethical considerations. Only individuals who signed a consent form, which included permission for the publication of anonymized responses and direct quotations, were enrolled. After providing consent, participants were informed that they could withdraw at any time and that their privacy would be protected.

Author Contributions

Study conception and design: MO. Data collection: MO, YI. Analysis and interpretation of the results: MO, HJ. Draft manuscript preparation: MO, HJ, ST, MM, YS. All authors made a significant contribution to the work reported, whether in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest related to this work.