Table 6.
Some interventions to improve dialysis outcomes
| Factors potentially leading to poor outcomes | Suggested Interventions | Objective Assessment (clinical / research purposes) |
|---|---|---|
| The decision to have dialysis framed as a choice as between dialysis (living) versus dying; decisional conflict | Specific discussions around choice; presentation of alternatives to dialysis such as maximal supportive care; involvement of family / carers in decision-making | Decision support aids (e.g., web-based aids, [33] |
| The Yorkshire Dialysis Decision Aid (YODDA) [34]) | ||
| The ‘SURE’ test [35] | ||
| Undue expectations of symptom benefit from dialysis | Discuss inconsistency of symptom relief; appearance of new symptoms with dialysis (e.g., needling pain, fatigue) | Symptoms /quality of life surveys [36] |
| Frailty indices [37] | ||
| Comprehensive Geriatric Assessments (CGA) [38] | ||
| Being ill-prepared for the restrictions and the reality of life on dialysis | Information tailored for the older patient (more time, more repetition); Specifically discuss restrictions to travel, diet, fluid intake | Assessment of health literacy [39] |
| Becker-Maiman model for analysis of compliance [40] | ||
| Beliefs and Behaviour Questionnaire (BBQ) [41] | ||
| Dialysis Diet and Fluid non-adherence Questionnaire [42]; Illness perception questionnaire [43] | ||
| Effects of ageing, physical or cognitive decline | Screen for frailty and risk of falls; prevent deterioration if possible, address frailty, monitor functional status, provide support before the patient “fails” | |
| Curtailment of activities outside dialysis; changing life-role | Explore personal values, discuss impacts of dialysis on the rest of the patient’s life | |
| The time commitment; losing time for ‘living’ | Specifically discuss time lost - including time needed for travel, and the time lost resting after dialysis. | |
| Impact and recurring nature of post-dialysis fatigue | Warn patients of cyclic nature of symptoms like post-dialysis tiredness and their impact on life | Dedicated fatigue scales / inventory [44] |
| Lack of a “positive attitude”, actively adapting to effects of dialysis on life | Clinician focus and involvement in facilitating psychological adaptation, consider behavioural therapy if needed | Illness perception questionnaire [43] |
| Inventory of Coping Strategies Used by the Elderly ICSUE [45] | ||
| Inability to maintain or enjoy goals /values / activities outside of dialysis | Encourage and plan with patients regarding: Selecting the right activities according to current limitations, optimising self for their performance, and making compensations / accepting help where needed | Life Attitudes Profile [46] |
| Personal Meaning Profile [47] | ||
| Loss of the feelings of being valued, loved, supported. | Focus on meaningful clinician interactions; monitor support from family, friends; Consider needs of carers. | Quality of life scales [36] |
| Trust in Physician Scale [48] | ||
| Zarit Burden Interview [49] |