FIGURE 1.

Thematic schema for patient interviews. Patients described perpetuating, interconnected physical and mood symptom cycles. A general resignation that their lives depended on machines appeared to influence how patients experienced these symptom cycles. This reality colored how patients understood, perceived and coped with symptoms as well as how they interacted with the dialysis care system. The figure displays the symptom cycle (first theme) as experienced through the lens of a machine-dependence reality (second theme). The remaining five themes (experiencing the life intrusiveness of dialysis, developing adaptive coping strategies, creating a personal symptom narrative, negotiating loss of control and encountering the limits of the dialysis delivery system) were experienced through this lens, which transformed and informed symptom experiences, perceptions and responses differently across patients. Bidirectional arrows indicate theme interrelationships. Collectively, the seven identified themes appeared to influence patient tendencies to report (versus not) symptoms to their care teams.