A Qualitative Study of Awareness in Earlier-Stage Chronic Kidney Disease

Sunday, 28 July 2019

Chieh-Ying Hu, MSN
Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Background: Most patients with chronic kidney disease (CKD) were unaware of their diagnosis until their disease developed into end stages. Data on United State in America estimated CKD awareness was less than 9.0%. In Taiwan, the awareness rate of CKD stage 1 to 3 was merely 2.66% to 4.10%. Awareness of CKD remains unacceptably low, it is not known whether current each patient’s unique experience of awareness is essential in supporting patient-centered care for patients with CKD.

Purpose: To find out awareness experience in Taiwanese patients with early stage CKD.

Methods: A descriptive qualitative design was conducted using semi-structured, in-depth interviews. Fifteen participants were purposively recruited from the nephrology department of three hospitals in Taiwan from October 2017 to July 2018. Descriptive statistics and content analysis were used for data analysis.

Results: New information does not fit expectations, leads to gap in understanding and initiates sense making. Thematic analysis was used to identify the participants’ experiences and six key themes emerged: difficulty in linking early stage symptoms to kidney diseases; unnoticeable disease symptoms; the lack of basic knowledge about kidney diseases; medical terminology unintelligible to patients; neglect in treatment due to overwhelming responsibility in multiple roles and communication barriers with healthcare providers.

Conclusion: These findings have implications for healthcare providers to enhance their understanding of the patient experience and improve their skills in motivational communication. Empowerment is a collaborative relationship in which providers function as educators or consultants to the patient. When patients choose behavior change that is personally meaningful, then they are more likely to make and sustain that behavior change. Moreover, individuals’ unique cultural and economic status all require that the individuals adapt general CKD education guidelines to their unique needs, values and priorities. We should be paid to supporting patients to set goals, strengthening intrinsic motivation, providing comprehensive and practical information, stimulating the self-monitoring of disease progression, and building a supportive patient– professional relationship that encompasses shared decision making and coaching.