Skip to main content

Table 6 Some interventions to improve dialysis outcomes

From: Enabling good outcomes in older adults on dialysis: a qualitative study

Factors potentially leading to poor outcomes

Suggested Interventions

Objective Assessment (clinical / research purposes)

The decision to have dialysis framed as a choice as between dialysis (living) versus dying; decisional conflict

Specific discussions around choice; presentation of alternatives to dialysis such as maximal supportive care; involvement of family / carers in decision-making

Decision support aids (e.g., web-based aids, [33]

The Yorkshire Dialysis Decision Aid (YODDA) [34])

The ‘SURE’ test [35]

Undue expectations of symptom benefit from dialysis

Discuss inconsistency of symptom relief; appearance of new symptoms with dialysis (e.g., needling pain, fatigue)

Symptoms /quality of life surveys [36]

Frailty indices [37]

Comprehensive Geriatric Assessments (CGA) [38]

Being ill-prepared for the restrictions and the reality of life on dialysis

Information tailored for the older patient (more time, more repetition); Specifically discuss restrictions to travel, diet, fluid intake

Assessment of health literacy [39]

Becker-Maiman model for analysis of compliance [40]

Beliefs and Behaviour Questionnaire (BBQ) [41]

Dialysis Diet and Fluid non-adherence Questionnaire [42]; Illness perception questionnaire [43]

Effects of ageing, physical or cognitive decline

Screen for frailty and risk of falls; prevent deterioration if possible, address frailty, monitor functional status, provide support before the patient “fails”

Curtailment of activities outside dialysis; changing life-role

Explore personal values, discuss impacts of dialysis on the rest of the patient’s life

The time commitment; losing time for ‘living’

Specifically discuss time lost - including time needed for travel, and the time lost resting after dialysis.

Impact and recurring nature of post-dialysis fatigue

Warn patients of cyclic nature of symptoms like post-dialysis tiredness and their impact on life

Dedicated fatigue scales / inventory [44]

Lack of a “positive attitude”, actively adapting to effects of dialysis on life

Clinician focus and involvement in facilitating psychological adaptation, consider behavioural therapy if needed

Illness perception questionnaire [43]

Inventory of Coping Strategies Used by the Elderly ICSUE [45]

Inability to maintain or enjoy goals /values / activities outside of dialysis

Encourage and plan with patients regarding: Selecting the right activities according to current limitations, optimising self for their performance, and making compensations / accepting help where needed

Life Attitudes Profile [46]

Personal Meaning Profile [47]

Loss of the feelings of being valued, loved, supported.

Focus on meaningful clinician interactions; monitor support from family, friends; Consider needs of carers.

Quality of life scales [36]

Trust in Physician Scale [48]

Zarit Burden Interview [49]