Abstract:
While there is no consensus on the definition of patient engagement there appears to be a concordance that it benefits both patients and health systems. From the literature there appears to be more support for the importance of patient engagement than tangible concrete measurements of its implied benefits. People with progressive chronic kidney disease face the issues and burden of a life threatening chronic condition. Planning for future renal replacement therapy usually commences when a patient is asymptomatic; this combined with an uncertain disease trajectory can make it difficult for patients to accept the need to plan. This project researched which factors increase or inhibit the engagement of patients with their planning for future renal replacement therapy within the Auckland District Health Board. A qualitative descriptive methodology utilising thematic analysis and a sensitive framework was utilised to explore patient engagement with the predialysis process and the unique experiences patients face. Fifteen people on renal replacement therapy participated in semi-structured interviews. Demographic and supporting information was accessed from medical records. Six influencing themes identified in the study were life, information, dealing with it, the multidisciplinary team, choice and symptoms. These factors can both facilitate and inhibit patient engagement. This study indicates continuous adaptation by the predialysis multidisciplinary team is required to continue to enhance health care provision and assist engagement with planning for renal replacement therapy. Predialysis service provision needs to be accessible and people with progressive chronic kidney disease need to perceive value with it. Patient-centred care requires robust assessment which will indicate factors that increase or inhibit engagement for the individual. Patients require an active role within the healthcare team. Patient acceptance of the need for future renal replacement therapy and engagement positively affects predialysis planning and self-management of chronic conditions.
