Journal
BMC NEPHROLOGY
Volume 13, Issue -, Pages -Publisher
BIOMED CENTRAL LTD
DOI: 10.1186/1471-2369-13-114
Keywords
Indigenous Australian; Hemodialysis; End stage kidney disease; Access to healthcare; Life experiences; Patient care; Health communication; Late diagnosis; Qualitative research
Categories
Funding
- National Health and Medical Research Council (NHMRC) [236204]
- NHMRC Senior Research Fellowship [457101]
- Australian Postgraduate Research Scholarship
- NHMRC Career Development Award [283310]
- Senior Research Fellowship [545200]
- Co-operative Research Centre for Aboriginal Health (CRCAH), Darwin
- NVIVO training
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Background: In common with Indigenous populations elsewhere, Indigenous Australians have higher incidence of end-stage kidney disease (ESKD), but lower transplantation rates than their non-Indigenous counterparts. Understanding how the demands of dialysis impact on, and are impacted by, the lives of Indigenous patients may provide important insight into treatment pathways and decision-making. Methods: We conducted semi-structured interviews in 2005-06 with 146 Indigenous and 95 non-Indigenous patients from nine hospital renal wards and 17 associated dialysis centres, which together treat the majority of Indigenous Australian ESKD patients. Results: Factors influencing treatment experience included: the impacts of late diagnosis; family separations associated with relocating for treatment; the physical and psychosocial demands of hemodialysis; and ineffective communication between health care providers and patients. Although not unique to them, Indigenous patients were more likely to experience the combined effect of all factors. Conclusions: Social/situational circumstances profoundly affect Indigenous Australian dialysis patients' ability to fully engage with treatment. This may ultimately affect their likelihood of receiving optimal treatment, including transplantation. Areas for improvement include: earlier diagnosis; improved linkages between specialist renal services and primary care in regional settings; more effective communication and patient education; and more systematic, transparent approaches to patient compliance in transplant and home dialysis guidelines.
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