J STEVENSON1,3, A TONG2,3, KL CAMPBELL5, JC CRAIG2,3, VW LEE1,3,4
1Westmead Clinical School, The University of Sydney, NSW; 2Sydney School of Public Health, The University of Sydney, Sydney, NSW; 3Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW; 4Department of Renal Medicine, Westmead Hospital, Sydney, NSW; 5Faculty of Health Sciences and Medicine, Bond University, Robina, QLD
Aim: To describe the perspectives of healthcare providers on the nutritional management in patients on haemodialysis.
Background: Nutritional management in haemodialysis is complex, with patients requiring support to make and sustain appropriate dietary behaviours. Multidisciplinary teams play an important role in managing nutritional priorities, providing counselling, and developing patients’ self-management skills.
Methods: Semi-structured interviews were conducted with 42 renal health professionals (nephrologists, nephrology trainees, nurses and dietitians) from 21 haemodialysis centres in Australia. Transcripts were analysed thematically.
Results: We identified six major themes: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgmental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies).
Conclusions: Organisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient-clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable dietary behaviour change. Improving service delivery and developing and delivering targeted, multi-faceted self-management interventions may enhance current nutritional management of patients on haemodialysis.