Mixed Methods Study of Symptom Experience in Patients with End-Stage Renal Disease
Publication in refereed journal
Officially Accepted for Publication


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AbstractBackground: Patients with end-stage renal disease (ESRD) receiving dialysis experience significant symptom burden. Identifying factors associated with this burden may improve symptom management. However, specific evidence about patients’ experiences is lacking.
Objectives: To explore factors that are associated with patients’ symptom experiences.
Methods: Convergent parallel mixed methods design was used. In the quantitative component, the Dialysis Symptom Index was used to assess the symptom burden of 271 patients. Its associations with patient characteristics were examined using correlation coefficients and multivariate regression analyses. In the qualitative component, associated factors reported by ten of these patients were identified through semi-structured interviews using content analysis. Assessments were conducted at enrollment, six, and twelve months. After separate data analyses, findings were integrated using side-by-side comparison and joint display.
Results: While several statistically significant associations were identified between patient characteristics and symptom burden, patients described four categories of factors (i.e., treatment-related, pathophysiological, situational, dietary) associated with a higher symptom burden during their interviews. Across both components of this study, three factors were consistent (i.e., employment, hyperphosphatemia, anemia). Patients described several factors that were not reported previously.
Discussion: This study explored subjective and objective factors influencing the symptom experiences of patients with ESRD using a mixed methods design. These risk factors can be used to identify high risk patients. In addition, our findings suggest that patients relied on laboratory results and treatments to explain their symptom experiences. These findings suggest that an assessment of both subjective and objective factors is needed to explore patients’ symptom experiences.
Acceptance Date09/08/2020
All Author(s) ListMarques Shek Nam Ng, Cho Lee Wong, Kai Chow Choi, Yun Ho Hui, Eva Hau Sim Ho, Christine Miaskowski, Winnie Kwok Wei So
Journal nameNursing Research
Year2020
ISSN0029-6562
eISSN1538-9847
LanguagesEnglish-United States
Keywordschronic kidney disease, end-stage renal disease, mixed methods, renal dialysis, symptoms

Last updated on 2021-26-02 at 23:59