What Philosophy of Health Professionals Enabled Japanese Hemodialysis Patients to Survive Longer?

Wednesday, 24 July 2013

Natsumi Morita, PhD
Faculty of Nursing and Medical Care,, Keio University, Fujisawa, Japan

Learning Objective 1: The learner will be able to describe a philosophy and perspective of health professionals that promoted longevity among Japanese hemodialysis patients.

Learning Objective 2: The learner will be able to describe an approach to improved care of the patient with hemodialysis and Chronic Kidney Disease (CKD).

Purpose: There are more than 300,000 hemodialysis patients in Japan, and 4% of them survive more than 25 years, which is longer than in Western countries. The reasons for longer survival may arise from both patients and health professionals. The purpose of this study was to explore the philosophy that health professionals believe promotes Japanese hemodialysis (HD) patients’ longer survival and what they perceived made the patients survive longer.

Methods: Qualitative design. Three physicians and 5 nurses who cared for longer survived HD patients were interviewed for about one hour each. Three of the 5 nurses were interviewed as a group. They gave informed consent to the use of their interview data for academic research. They were asked what philosophy promoted HD patients’ longer survival and what they perceived as the patients’ contributions to survival. All interviews were tape-recorded, then transcribed. The author read and re-read the data and distilled the philosophy using a qualitative interpretive approach. Interviews were conducted, transcribed, and analyzed in Japanese. This research was approved by the IRB of Keio University.

Results: The major themes of the professionals’ philosophy were: “proper treatment of HD”, “proper intake of food and fluid”, “respect for patients’ own way of managing their lives with HD” and “open relationship between health professionals and patients”. Health professionals’ perceptions of patients’ contributions to longer survival were: “strong will to live/survive” and “reasonable management: avoiding overly rigid restriction of food and fluid.”

Conclusion: Most of these health professionals thought that compliance with the self-care regimen restricting food and fluid will lead to longer survival. At the same time, however, although it varied based on patients’ status, they suggested that too much restriction is not good for longer survival. Open communication can promote respect for survivors’ autonomy, although paternalism still remains in Japan’s medical world.