Patients' experiences of cannulation of arteriovenous access for haemodialysis: A qualitative systematic review

INTRODUCTION

Cannulation is an essential part of haemodialysis with arteriovenous access. Patients' experiences of cannulation for haemodialysis are problematic but poorly understood. This review aims to synthesise findings related to patients' experiences of cannulation for haemodialysis from qualitative studies, providing a fuller description of this phenomenon.

METHODS

Eligibility criteria defined the inclusion of studies with a population of patients with end-stage kidney disease on haemodialysis. The phenomena of interest was findings related to patients' experiences of cannulation for haemodialysis and the context was both in-centre and home haemodialysis. MedLine, CINAHL, EMBASE, EMCARE, BNI, PsycInfo and PubMed were last searched between 20/05/2019 and 23/05/2019. The quality of studies was assessed using the using Joanna Briggs Critical Appraisal Checklist for Qualitative Research. Meta-aggregation was used to synthesise findings and CERQual to assess the strength of accumulated findings.

RESULTS

This review included 26 studies. The subject of included studies covered cannulation, pain, experiences of vascular access, experiences of haemodialysis and a research priority setting exercise. From these studies, three themes were meta-aggregated: (1) Cannulation for haemodialysis is an unpleasant, abnormal and unique procedure associated with pain, abnormal appearance, vulnerability and dependency. (2) The necessity of cannulation for haemodialysis emphasises the unpleasantness of the procedure. Success had multiple meanings for patients and patients worry about whether the needle insertion will be successful. (3) Patients survive unpleasant, necessary and repetitive cannulation by learning to tolerate cannulation and exerting control over the procedure. Feeling safe can help them tolerate cannulation better and the cannulator can invoke feeling safe. However, some patients still avoid cannulation, due to its unpleasantness.

CONCLUSIONS

Cannulation is a pervasive procedure that impacts on patients' experiences of haemodialysis. This review illuminates further patients' experiences of cannulation for haemodialysis, indicating how improvements can be made to cannulation.

REGISTRATION

PROSPERO (CRD42019134583).

An exploration of successful psychosocial adjustment to long-term in-centre haemodialysis

OBJECTIVES

Haemodialysis extends life for people with end-stage kidney disease (ESKD) worldwide, but it imposes significant psychosocial burdens and there is little evidence about successful adjustment. This study aimed to improve understanding of successful psychosocial adjustment to in-centre haemodialysis (ICHD; dialysis in a hospital or satellite unit).

METHODS

Individual semi-structured interviews were conducted with a purposive sample of 18 people with ESKD who had all received in-centre haemodialysis in the UK for at least 90 days in the last two years. An inductive thematic analysis was employed to identify themes from the verbatim interview transcripts.

RESULTS

There were four themes: 1) reaching a state of acceptance, which described the importance of accepting the necessity of dialysis; 2) taking an active role in treatment, which described how being actively involved in treatment gave participants greater feelings of autonomy and control; 3) utilising social support networks, which described the benefits of instrumental and emotional support; and 4) building emotional resilience, which described the importance of optimism and positivity.

CONCLUSIONS

The themes demonstrated elements of successful adjustment that could be targeted by interventions to promote psychological flexibility and positive adjustment among people receiving in-centre haemodialysis worldwide.

Using patient feedback to adapt intervention materials based on acceptance and commitment therapy for people receiving renal dialysis

Background

Theory-based intervention materials must be carefully adapted to meet the needs of users with specific physical conditions. Acceptance and Commitment Therapy (ACT) has been adapted successfully for cancer, chronic pain, diabetes, irritable bowel syndrome, multiple sclerosis, and a range of other conditions, but not so far for people receiving renal haemodialysis. This paper presents findings from a study to adapt ACT-based intervention materials specifically for renal dialysis.

Methods

Draft written materials consisting of four stories depicting fictitious individuals who used ACT-related techniques to help overcome different challenges and difficulties related to dialysis were adapted using a systematic patient consultation process. The participants were 18 people aged 19–80 years, with chronic kidney disease and receiving renal dialysis. Individual, semi-structured interviews were conducted to elicit participants’ views about how the content of the draft materials should be adapted to make them more realistic and relevant for people receiving renal dialysis and about how the materials should be presented and delivered to people receiving renal dialysis. The interview transcripts were analysed using a qualitative adaptation of the Delphi method in which themes are used as a framework for translating feedback into proposals for modifications.

Results

The analysis of patient feedback supported the use of patient stories but suggested they should be presented by video and narrated by real dialysis patients. They also indicated specific adaptations to make the stories more credible and realistic. Participant feedback was translated into proposals for change that were considered along with clinical, ethical and theoretical factors. The outcome was a design for a video-based intervention that separated the stories about individuals from the explanations of the specific ACT techniques and provided greater structure, with material organised into smaller chunks. This intervention is adapted specifically for people receiving renal dialysis while retaining the distinctive theoretical principles of ACT.

Conclusions

The study shows the value of consulting patients in the development of intervention materials and illustrates a process for integrating patient feedback with theoretical, clinical and practical considerations in intervention design.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12894-021-00921-5.

Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

BACKGROUND

Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness.

IMPACT

The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

Effect of adding a compassion-focused intervention on emotion, eating and weight outcomes in a commercial weight management programme

This study examined whether adding a compassion-focused light touch digital intervention into a commercial multicomponent weight management programme improved eating behaviour, self-evaluation and weight-related outcomes. The compassion intervention significantly reduced binge eating symptomatology and dropout, and improved psychological adjustment and self-evaluation, but did not affect weight outcomes. Compassion, self-reassurance and reductions in shame and self-criticism mediated the effect of the intervention on reductions of binge eating symptomatology. Negative self-evaluation, binge eating symptomatology, susceptibility to hunger and eating guilt were significant predictors of dropout. Findings suggest that compassion-based digital tools may help participants better manage binge eating symptomatology and self-evaluation in weight management interventions.

The Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale: Confirmatory Factor Analysis and associations with control, loss of control of eating and weight in overweight and obese women

OBJECTIVES

The Weight-Focused Forms of Self-Criticising/Attacking and Self-Reassuring Scale (WFSCRS) is based on the original Forms of Self-Criticising/Attacking and Self-Reassuring Scale (FSCSRS; Gilbert et al., 2004, British Journal of Clinical Psychology, 43, 31) and assesses the inadequate and hated forms of self-criticism and the ability to self-reassure when coping with attempts to control body weight, shape, and eating. The aim of this study was to examine the factor structure, consistency, and reliability of the WFSCRS in overweight and obese women.

METHODS

The factorial structure of the WFSCRS was examined through a confirmatory factor analysis in 724 overweight and obese women participating in a commercial weight management programme. The scale's construct and convergent validity were also examined.

RESULTS

The WFSCRS had a three-factor structure, similar to the FSCSRS, which fitted the data well. The WFSCRS had high internal reliability, construct, and discriminant validity. The scale was positively associated with measures of shame, body image, eating-related difficulties, symptoms of anxiety, depression, and stress, and body mass index (BMI). The two forms of self-criticism were significantly associated with higher BMI, and this effect was mediated by increased loss of control over eating (for both forms) and decreased flexible control over eating (for the hated self form).

CONCLUSIONS

The WFSCRS is a valid measure for assessing self-reassurance and two denigratory forms (inadequate self and hated self) of self-criticism in people who are overweight and obese.

PRACTITIONER POINTS

The WFSCRS was developed to measure weight/shape and eating-related self-criticism and self-reassurance. The WFSCRS was examined in a large sample of overweight and obese women attending a community-based weight management programme. The WFSCRS presented a three-factor structure measuring two forms of self-criticism (inadequate self and hated self) and the ability to be self-reassuring. The two forms of self-criticism and self-reassurance are differentially associated with BMI, through the mediating effect of loss of control over eating and flexible control over eating.

The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults

INTRODUCTION

Obesity and associated diseases place a severe burden on healthcare systems. Behavioural interventions for weight loss (WL) are successful in the short term but often result in weight regain over time. Self-regulation of eating and activity behaviours may significantly enhance weight loss maintenance (WLM) and may be effectively augmented by contextual behavioural approaches to emotion regulation. The NoHoW trial tests the efficacy of a theoretically informed, evidence-based digital toolkit using a mobile-enabled website, activity trackers and Wi-Fi scales for WLM aiming to target (1) self-regulation and motivation, and (2) emotion regulation in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial body mass index (BMI) ≥25 kg/m²).

METHODS AND ANALYSIS

The study is an 18-month, 3-centre, 2×2 factorial single-blind, randomised controlled trial, which recruited 1627 participants achieving ≥5% WL between March 2017 and March 2018. Participants are randomly allocated to one of four arms: (1) self-monitoring only (self-weighing and activity tracker), (2) self-regulation and motivation, (3) emotion regulation or (4) combined self-regulation, motivation and emotion regulation. Participants attend four clinical investigation days at 0, 6, 12 and 18 months and are instructed to use the digital toolkit for 18 weeks during the first 6 months and at their discretion for the remaining 12 months. The primary outcome is change in weight (kg) at 12 months from baseline. Secondary outcomes are body composition (eg, bioimpedance analysis), health biomarkers (glycated haemoglobin, lipids, blood pressure, hair cortisol), dietary intake, physical activity, sleep, motivational, self-regulatory, emotion regulatory moderators/mediators of WLM, engagement, user experience, acceptability and cost-effectiveness of the interventions.

ETHICS AND DISSEMINATION

Ethical approval was granted by Institutional Ethics Committees at the Universities of Leeds (17-0082; 27 February 2017), Lisbon (17/2016; 20 February 2017) and Capital Region of Denmark (H-16030495, 8 March 2017). Results will be published in scientific journals.

TRIAL REGISTRATION NUMBER

ISRCTN88405328.

Parental self-efficacy in managing food allergy and mental health predicts food allergy-related quality of life

BACKGROUND

Food allergy has been shown to have a significant impact on quality of life (QoL) and can be difficult to manage in order to avoid potentially life-threatening reactions. Parental self-efficacy (confidence) in managing food allergy for their child might explain variations in QoL. This study aimed to examine whether self-efficacy in parents of food allergic children was a good predictor of QoL of the family.

METHODS

Parents of children with clinically diagnosed food allergy completed the Food Allergy Self-Efficacy Scale for Parents (FASE-P), the Food Allergy Quality of Life Parental Burden Scale (FAQL-PB), the GHQ-12 (to measure mental health) and the Food Allergy Independent Measure (FAIM), which measures perceived likelihood of a severe allergic reaction.

RESULTS

A total of 434 parents took part. Greater parental QoL was significantly related to greater self-efficacy for food allergy management, better mental health, lower perceived likelihood of a severe reaction, older age in parent and child and fewer number of allergies (all p < 0.05). Food allergy self-efficacy explained more of the variance in QoL than any other variable and self-efficacy related to management of social activities and precaution and prevention of an allergic reaction appeared to be the most important aspects.

CONCLUSIONS

Parental self-efficacy in management of a child's food allergy is important and is associated with better parental QoL. It would be useful to measure self-efficacy at visits to allergy clinic in order to focus support; interventions to improve self-efficacy in parents of food allergic children should be explored.

Effects of a pain self-management intervention combining written and video elements on health-related quality of life among people with different levels of education

Combining written and video material could increase the impact of health education for people with less education, but more evidence is needed about the impact of combined materials in different formats, especially in the context of chronic pain self-management. This study tested the impact of combining written information about self-managing chronic joint pain, which used language at a high reading level, with a DVD containing narrative video material presented directly by patients, using language at a lower reading level. Physical and mental health-related quality of life (36-Item Short Form Health Survey) was measured among 107 men with hemophilia before and 6 months after being randomly assigned to receive an information booklet alone or the booklet plus the DVD. Analysis of covariance was used to compare health outcomes between randomized groups at follow-up, using the baseline measures as covariates, with stratified analyses for groups with different levels of education. The DVD significantly improved mental health-related quality of life among those with only high school education. Video material could therefore supplement written information to increase its impact on groups with less education, and combined interventions of this type could help to achieve health benefits for disadvantaged groups who are most in need of intervention.

Asking women survivors about thoughts or actions involving sex with children: an issue requiring therapist sensitivity

This article reports findings from the qualitative phase of a mixed-methods study exploring whether current counseling practices with women survivors of child sexual abuse include inquiry about thoughts and behavior involving sex with children. Following an online survey of therapists across Canada, telephone interviews were conducted with a subgroup of 22 therapists. Two main themes emerged: (a) the dilemma for the therapist and (b) strategies to explore the issue. The "dilemma" refers to the therapeutic reasons and ethical responsibility to have this discussion versus the possible negative effects on the client and/or the therapeutic relationship, the discomfort of the therapist, and inadequate training. Strategies to explore the issue are presented including normalizing, ensuring client understanding, and using different types of inquiry.

Validation of the Food Allergy Quality of Life-Parental Burden Questionnaire in the UK

PURPOSE

Food allergy can have a profound effect on quality of life (QoL) of the family. The Food Allergy Quality of Life-Parental Burden Questionnaire (FAQL-PB) was developed on a US sample to assess the QoL of parents with food allergic children. The aim of this study was to examine the reliability and validity of the FAQL-PB in a UK sample and to assess the effect of asking about parental burden in the last week compared with parental burden in general, with no time limit for recall given.

METHODS

A total of 1,200 parents who had at least one child with food allergy were sent the FAQL-PB and the Child Health Questionnaire (CHQ-PF50); of whom only 63% responded.

RESULTS

Factor analysis of the FAQL-PB revealed two factors: limitations on life and emotional distress. The total scale and the two sub-scales had high internal reliability (all α > 0.85). There were small to moderate but significant correlations between total FAQL-PB scores and health and parental impact measures on the CHQ-PF50 (p < 0.01). Significantly greater parental burden was reported for the no-time limited compared with the time-limited version (p < 0.01).

CONCLUSIONS

The FAQL-PB is a reliable and valid measure for use in the UK. The scale could be used in clinic to assess the physical and emotional quality of life in addition to the impact on total quality of life.

Trends in prescribing and self-poisoning in relation to UK regulatory authority warnings against use of SSRI antidepressants in under-18-year-olds

AIMS

To assess the impact of the UK Medicines and Healthcare products Regulatory Authority (MHRA) warning in December 2003 not to prescribe selective serotonin reuptake inhibitor (SSRI) antidepressants, except fluoxetine, to under-18-year-olds.

METHODS

Interrupted time series analysis of prescriptions (UK) and general hospital presentations for nonfatal self-poisoning (three centres in England) for 2000-2006.

RESULTS

Following the MHRA warning in December 2003 there were significant decreases in prescribing of SSRI antidepressants (conservative estimate 51%) to young people aged 12-19 years. Surprisingly, this decrease also affected fluoxetine (conservative estimate 20%) and tricyclics (conservative estimate 27%). Nonfatal self-poisoning in this age group following the warning also declined significantly for SSRIs (conservative estimate 44%), but not for fluoxetine, tricyclic antidepressants, or all drugs and other substances. Rates of nonfatal self-harm did not change significantly over the study period.

CONCLUSIONS

The reduction in both prescribing and self-poisoning with SSRI antidepressants (except fluoxetine) following the MHRA warning is in keeping with reduced availability of these drugs. There was some evidence of substitution from other SSRIs to fluoxetine for use in self-poisoning. Importantly, overall rates of nonfatal self-harm and self-poisoning did not change, indicating no substitution of method or increases in self-injury.

Towards malecentric communication: sensitizing health professionals to the realities of male childhood sexual abuse survivors

This article extends earlier reports of an ongoing qualitative inquiry on childhood sexual abuse survivors' experiences with health professionals. In this paper, we aim to enhance understanding of male survivors' experience. While male and female participants express similar anxieties and fears about their encounters with health professionals, there are gender-based differences related to the perceptions of victimhood and manhood; guilt and shame; homophobia; disclosure of abuse; and the expression of vulnerability. The implications of these differences for sensitive health care practice are analyzed within the context of gender relationships and the differential socialization of men. Malecentric communication is proposed as a method for addressing the specific experiences of male survivors in their encounters with health professionals.

What works for survivors of childhood abuse: learning from participants in an inpatient treatment program

Thirty adults were interviewed about their experiences in a 6-week program for recovery from posttraumatic stress. The most valued aspects were their relationships with staff and the staff's expertise in treating the long-term effects of abuse. They valued the structured group treatment that allowed them to process emotions with the goal of healing. A few were upset by process groups, whereas others had difficulty with the sudden loss of support at discharge from the program.

Chronic pain and health care utilization in women with a history of childhood sexual abuse

OBJECTIVE

This cross-sectional controlled study investigated the association between chronic pain, health care utilization and a history of childhood sexual abuse.

SUBJECTS

Three groups, constituting 80 women in total, were studied (1) attendees at group therapy for individuals who had experienced childhood sexual abuse (n = 26); (2) Two control groups consisting of nonabused (a) psychiatric outpatients (n = 33); and (b) nurses (n = 21).

SETTING

The setting was a university affiliated community and tertiary care hospital in London. Ontario.

OUTCOME MEASURES

Each subject voluntarily completed questionnaires documenting history of childhood abuse, pain, psychological symptomatology and medical and surgical history.

RESULTS

Sixty-nine percent of the women who had experienced childhood sexual abuse reported a chronic painful condition lasting more than three months, compared to 43% of the combined control groups (p = .026). Women who had experienced childhood sexual abuse reported a greater number of painful body areas (p = .003), more diffuse pain and more diagnoses of fibromyalgia (p = .013). They had more surgeries (p = .037), hospitalizations (p = .0004) and family physician visits (p = .046).

CONCLUSIONS

Women with a history of childhood sexual abuse reported more chronic pain symptoms and utilized more health care resources compared to nonabused control subjects. Identification of such a history in the patient experiencing persisting pain may be the first step toward a successful combination of medical and psychosocial interventions.

The impact of group therapy for adult survivors of childhood sexual abuse

This article reports on 95 women who were referred to an outpatient psychiatry clinic for group therapy for adult survivors of childhood sexual abuse. Criteria for exclusion in group therapy are outlined and the format of the group therapy is described. Those who completed the groups are compared to dropouts. The group's effectiveness was evaluated using measures of psychiatric symptomatology (SCL 90), depression (Zung Self-Report Depression Scale), and self-esteem (Texas Social Behaviour Inventory) with a pre/post test design. Clients' evaluation questionnaires were also used. Group therapy was found to be effective in reducing symptomatology and change was in the expected direction in terms of depression and self-esteem.