Unmet Palliative Care Needs of Patients on Maintenance Hemodialysis at Thika Level 5 Hospital, Kiambu County, Kenya
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Date
2024-06
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Kenyatta University
Abstract
Globally, a huge gap exists between the required and the available renal palliative care services. The gap is particularly worse in low-and-medium income countries despite having the highest percentage of patients requiring palliative care. Maintenance hemodialysis patients contribute a sizable percentage of the global renal patient population in need of palliative care. Successful provision of adequate palliative care services requires a holistic understanding of the patients’ needs. In Kenya, however, data on palliative care needs of patients on maintenance hemodialysis is limited. This study was conducted to explore the unmet palliative care needs of patients on maintenance hemodialysis at Thika Level 5 Hospital, Kiambu County. The specific objectives of the study were to assess the physical, psychological and social palliative care needs of patients on maintenance hemodialysis and identify the patient related barriers to meeting these needs. A descriptive qualitative study anchored by the 6-S model for person centered palliative care was conducted using twelve purposively sampled patients on maintenance hemodialysis at Thika Level 5 Hospital’s renal unit. Participants in the study were 18 years and above, had been receiving maintenance hemodialysis therapy at the renal unit for more than six months and could speak either English or Kiswahili. Those with cognitive impairment, critical illness and had undergone kidney transplantation were excluded. Data collection was done using semi-structured audiotaped interviews which lasted between 30-45 minutes. An interview guide based on the Integrated Palliative Outcome Score (IPOS) renal survey was used to conduct the interviews. Data collection was done until saturation was reached. The recorded interviews were transcribed verbatim and analyzed using thematic analysis. NVIVO 14 qualitative data analysis software was used to analyze the data. The six general principles of thematic analysis including familiarizing with the data set, initial generation of codes, searching for themes, reviewing themes, defining and naming themes and producing the report were used to guide the process. Ethical approval to conduct the study was obtained from Kenyatta University Graduate School, Kenyatta University Ethics and Review Committee (KUERC), the National Commission for Science, Technology and Innovation (NACOSTI), County Government of Kiambu and Thika Level 5 Hospital Training, Research and Ethics Committee (TREC). Eight major themes including distressing physical symptoms, difficult thoughts, interrupted relationships, financial burden on the family, abandonment by friends, spiritual coping and barriers to palliative care emerged from the data analysis. Also, eleven sub-themes including fatigue, fluctuations in appetite, skin changes, uncertainty about the future, stress and worry, inability to get more children, caregiver burden, prayers, material support, lack of knowledge and fear of being judged were identified. This study reports that patients on maintenance hemodialysis experience numerous unmet palliative care needs. The needs regard to physical, psychological and social aspects. Also, lack of knowledge on palliative care is the primary patient related barrier to meeting palliative care needs. The study underscores that the provision of timely, specific and adequate palliative care is needed to enhance the coping and survival of patients on maintenance hemodialysis. Furthermore, the study urges more strategies to be put in place to ensure patients on maintenance hemodialysis and their families are well educated on renal palliative care.
Description
A Thesis Submitted in Partial Fulfillment of the Requirements for the Award of the Degree of Master of Science (Nephrology Nursing) in the School of Health Sciences of Kenyatta University, June 2024