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S 17 Parallel Session
Programme of the Session
Title: The patient experience
GS: Leonidas Mourelatos (Greece)
A 35 year challenging journey
O 32
Experiences of shared decision making in adult pre-dialysis patients and carers
Sarah Ofori-Ansah (UK)
O 33
View of renal patients and general practitioners on coordination of care
Annelies Hellemans (Belgium)
O 34
How the haemodialysis patients see the arteriovenous fistulae cannulation technique
Jorge Melo (Portugal)
O 35
Patients’ satisfaction with care about their treatment of chronic renal failure
Céline Olbrechts (Belgium)
Abstracts
GUEST SPEAKER
35 year challenging journey
L. Mourelatos1
1Kefalonia, Greece
Background
At the age of 9, in 1981, my journey began, having being diagnosed with kidney failure. My treatment consisted of dialysis, in Greece. In 1984, I came to London and in 1985, I had my first kidney transplant. This was a success as it lasted for 11 years. In 1996, my body rejected the kidney and I was back to dialysis. In 2002, I had my second transplant and it lasted for 3 years. From 2005, I went back to dialysis again and I went on the waiting list for my third transplant.
Objectives
To share my experience and help others in anyway possible.
Methods
Presentation of speaking and slides/photos.
Conclusion/Application to practice
I feel that psychological and emotional support is essential in the dialysis unit.
BIOGRAPHY OF THE GUEST SPEAKER
O 32
Experiences of shared decision making in adult pre-dialysis patients and carers
S. Ofori-Ansah1
1Sussex Kidney Unit, BSUH, Brighton, United Kingdom
Background
Chronic kidney disease is an irreversible chronic condition, can progress to kidney failure and is treated with dialysis or potential kidney transplantation or no treatment. Evidence suggests that patients and carers become less engaged and are not able to make timely decisions on their treatment options. However, there is less literature on issues relating to the decision making process from the patients and carers perspective.
Objectives
This study explored the lived experiences of being involved in shared decision making to identify common themes and for factors that enhances or deter their engagement.
Methods
This is a qualitative study that used semi-structured interviews. Sixteen participants were recruited from an acute hospital to the study and interviewed.
Results
There are mixed responses regarding patient involvement in decisions about their treatment options. While some patients and carers preferred to be actively involved ,others chose to be passive.
Conclusion/Application to practice
The study will provide an understanding of patient and carer experience of decision making and may contribute to policies on service delivery on effective patient and carer education from their perspective.
O 33
View of renal patients and general practitioners on coordination of care
A. Hellemans1, K. Dierickx1, E. Hallez1, D. Kuypers1, K. Claes1
1Nephrology, University Hospitals of Leuven, Leuven, Belgium
Background
Progression of Chronic Kidney Disease (CKD) can be delayed by adequate treatment of hypertension, obesity and behavioural changes such as treatment adherence, smoking cessation and an active life style. Integrated care with intense cooperation between general practitioners (GP’s) and nephrologists is imperative to reach this goal.
Objectives
The aim of this study is to evaluate the perspective of patients and general practitioners on the coordination of care.
Methods
456 patients with CKD from the University Hospitals of Leuven were included in this study. Patients completed a standardized questionnaire. The study included 205 CKD stage IIIb-IV, 129 haemodialysis, 22 peritoneal dialysis and 100 transplanted patients. 47 GP’s were enrolled.
Results
The majority of patients chose the nephrologist as coordinator of their care. The main reason was the frequent visits to the outpatient clinic and dialysis unit. In contrast GP’s found GP's to be the main coordinator especially for the treatment of hypertension, diabetes, pain therapy and preventive care. 52,1% of the GP’s actively support patients with CKD in behavioural changes and 81,3% of the GP’s admit that their knowledge about renal pathology and treatment is too limited. 85,4% would accept the active role of a renal nurse for care coordination.
Conclusion/Application to practice
The majority of patients viewed the nephrologist as their care coordinator as opposed to the GP’s. GP’s acknowledge the aid of a nurse practitioner. Further research is necessary to define the effect and exact role of a renal nurse in the transmural care of patients with CKD.
O 34
How the haemodialysis patients see the arteriovenous fistulae cannulation technique
J. Melo1, P. Goncalves1, R. Sousa1, S. Campos1, A. Anjos1, R. Peralta2, J. Fazendeiro Matos2
1NephroCare Viseu, Fresenius Medical Care, Viseu, Portugal; 2NephroCare Portugal, Fresenius Medical Care, Porto, Portugal
Background
Vascular access has been justly described as both the lifeline and the Achilles’ heel of haemodialysis therapy. An appropriate technique is vital to the preservation of the arteriovenous fistulae (AVF) and nursing teams have to involve patients and their families in the process. But there are no data relating to patient participation in this role.
Objectives
• To understand how patients see cannulation technique of their AVF.
Methods
We developed a longitudinal quantitative, exploratory, descriptive study, through the application of a cannulation technique survey which included various items about the vascular access like:
• how the patient observes the technique and how they feel about it;
• if this process influences treatment adherence positively.
Results
Questionnaires were applied to all patients with AVF in our unit.
Most patients are cannulated with multiple single puncture technique, followed by buttonhole and finally rope-ladder and area techniques.
Generally, all patients are satisfied with the technique in use.
Over 75% state that they were previously informed about cannulation techniques and were involved in the choice of the technique.
Only 32% of patients reported that pain associated with cannulation is very low. Regardless of the technique used, pain is the main disadvantage mentioned.
About 91% reported that the nursing team takes extreme care when providing vascular access care and that this facilitated the adherence to haemodialysis treatment.
Conclusion/Application to practice
Although there is no perfect cannulation technique, these results do however show that our patients are satisfied with the cannulation technique in use and say that the vascular access care allowed for better treatment adherence.
O 35
Patient satisfaction with care about their treatment of chronic renal failure
C. Olbrechts1, N. Van Paesschen1, S. Crols1, M. Roden1, C. Tielemans1, R. Buyl1, Nursing Staff Haemodialysis Unit UZ Brussel1
1Haemodialysis Department, UZ Brussel University Hospital, Brussel, Belgium
Background
The number of patients in need of dialysis treatment in our country has increased in the past 15 years. Chronic renal failure and its treatment mean a major and time-consuming event in the life of such patients. Qualitative care, adapted to patients’ needs, is important because of the long-term and intense care relationship. Patient's satisfaction is a quality indicator of this, but there is a lack of research.
Objectives
Besides identifying the satisfaction of dialysis patients, this study aims to provide a base for practical interventions.
Methods
A quantitative cross sectional study was conducted on one dialysis ward.
All of the patients of the centre on haemodialysis and peritoneal dialysis who met the inclusion criteria were included.
Patients were surveyed using the standardised CHOICE-satisfaction questionnaire, completed with 3 general questions on a VAS-scale, translated into French and Dutch.
Results
Seventy patients participated, of which 41.4% experience their dialysis care in general as excellent and 70.8% would without doubt recommend the centre. In general satisfaction with nephrologists is rated lower than with the staff, and in addition high care patients score the physician even lower. Communication-aspects of the nephrologist are experienced least well, with helpfulness and caring of the staff as best. There is overall dissatisfaction with coordination between physicians. Moreover, people who are single or live alone are even more dissatisfied.
Conclusion/Application to practice
Improvements in satisfaction are possible by modifications in communication, and by using an integrated communication tool in the patient's records.