Karen Pugh-Clarke1, Sue Cheryl Read2, Julius Sim3. 1. Kidney Unit, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK. 2. Keele University School of Nursing and Midwifery, Clinical Education Centre, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK. 3. Keele University Research Institute for Applied Clinical Sciences, Keele, Staffordshire, UK.
Abstract
BACKGROUND: Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites of high-quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory. This paper reports the findings of the preliminary phase of a study aimed at exploring the symptom experience in patients with CKD stages 4 and 5. METHODS: Eighteen semi-structured patient interviews were conducted, using an interview schedule developed specifically to guide discussion. Data were analysed using thematic analysis to identify symptom categories and thematic patterns across the patient experiences. RESULTS: Patients reported a wide range of symptoms, with over 50 different categories and sub-categories emerging from the interview data. Symptom categories could be broadly classified into physical symptoms, such as 'Altered taste perception', 'Sleep disturbance' and 'Fatigue', and psychological symptoms, such as 'Forgetfulness', 'Poor concentration' and 'A sensation of gradually slowing down'. Of note, when questioned further, patients indicated that they would not usually report their symptoms to clinicians. CONCLUSIONS: This study suggests that patients with CKD stages 4 and 5 may have a high symptom burden. The finding that patients did not routinely report their symptoms emphasises a need for clinicians to incorporate symptom assessment into routine clinical consultations.
BACKGROUND: Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites of high-quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory. This paper reports the findings of the preliminary phase of a study aimed at exploring the symptom experience in patients with CKD stages 4 and 5. METHODS: Eighteen semi-structured patient interviews were conducted, using an interview schedule developed specifically to guide discussion. Data were analysed using thematic analysis to identify symptom categories and thematic patterns across the patient experiences. RESULTS:Patients reported a wide range of symptoms, with over 50 different categories and sub-categories emerging from the interview data. Symptom categories could be broadly classified into physical symptoms, such as 'Altered taste perception', 'Sleep disturbance' and 'Fatigue', and psychological symptoms, such as 'Forgetfulness', 'Poor concentration' and 'A sensation of gradually slowing down'. Of note, when questioned further, patients indicated that they would not usually report their symptoms to clinicians. CONCLUSIONS: This study suggests that patients with CKD stages 4 and 5 may have a high symptom burden. The finding that patients did not routinely report their symptoms emphasises a need for clinicians to incorporate symptom assessment into routine clinical consultations.
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