P168
FACTORS INFLUENCING ADHERENCE TO A RENAL THERAPEUTIC REGIMEN:
THE PERSPECTIVES OF CHINESE PATIENTS UNDERGOING CONTINUOUS
AMBULATORY PERITONEAL DIALYSIS
Lam, L, Lee, D, Shiu, A
The Nethersole School of Nursing, The Chinese University of Hong Kong
INTRODUCTION: Patients undergoing dialysis have to adhere to a renal therapeutic regimen comprising four components (dietary and fluid restrictions, and medication and dialysis prescriptions) to decelerate disease progression. Patient adherence has become healthcare professionals’ major concern. A range of demographic, clinical and psychosocial factors have been examined as potential determinants of patients’ adherence behaviour. Except for age, no factors have demonstrated persistent correlation with patients’ adherence. In addition, these studies are mainly on haemodialysis-treated patients and from healthcare professionals’ perspectives. Although a few studies used a quantitative approach to investigate adherence from patients’ perspectives, participants were not asked to provide explanation for their behaviour.
This study aimed to understand adherence from the perspectives of Chinese patients receiving continuous ambulatory peritoneal dialysis so as to identify factors influencing their adherence.
METHODS: A mixed methods design with two phases, the phase I survey and the phase II semi-structured interview, was used. This abstract presented phase II of the study.
The study was conducted in a renal unit of an acute hospital. Based on the phase I survey results, a maximum variation sampling method was employed to purposively recruit 36 participants of different genders (18 male participants), ages (35–76 years), and lengths of dialysis experiences
(11–103 months) for the phase II interview. Data were collected by tape-recorded semistructured interview. Content analysis was employed to analyse the transcribed data. Data collection and analysis were conducted simultaneously.
FINDINGS: Two major factors influencing participants’ adherence were support and hope for the future. Participants’ main sources of support were their family and healthcare professionals.
Family support was primarily provided by children and spouse in the form of accommodating their need for dietary restrictions, consoling them, helping them with household duties, accompanying them for follow-up visits, and visiting them during hospitalization. Participants’ adherence to the therapeutic regimen to prevent complications served as a return of their concern and love to their family. Healthcare professionals were participants’ second major source of support. Participants were grateful to doctors and nurses who provided them detailed information with patience, showed concern about their health, and understood their suffering.
Reinforcement of adherence, if delivered in a caring attitude, was well received and translated into practice. If participants were blamed for their non-adherence without being asked to attribute the causes, they were less willing to do as instructed because they perceived that healthcare professionals did not understand the hardship they had to endure.
Hope for the future included undergoing renal transplant and maintaining the current stable health status. Participants who lived with hope had greater motivation to adhere to instructions.
Those who were pessimistic about the future spoke of enjoying the present moment by indulging themselves in their preferred lifestyles and lived their life day by day.
CONCLUSION: The study revealed different sources and kinds of support Chinese patients received and their hope for the future, which were major factors influencing their adherence to the renal therapeutic regimen. To facilitate patients to live with the disease and the endless treatment, ongoing support is of vital importance. Drawing on patients’ family support enables them to cope with the major lifestyle changes. Providing relevant comments and detailed explanation in a caring and understanding manner enhances nurse-patient relationship and subsequently sustains patients’ persistence in adherence. Empowering patients to engage in selfmanagement of their disease facilitates them to maintain their stable health condition and live with minimal intrusion of the disease into their preferred lifestyles.