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外文期刊>Canadian Journal of Kidney Health and Disease
>Community-Based Dialysis in Saskatchewan First Nations: A Grassroots Approach to Gaining Insight and Perspective From First Nations Patients With Chronic Kidney Disease
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Community-Based Dialysis in Saskatchewan First Nations: A Grassroots Approach to Gaining Insight and Perspective From First Nations Patients With Chronic Kidney Disease
English French Background: Renal replacement options or dialysis can be delivered in the home setting or hospital setting. Home dialysis offers a number of benefits over hospital-delivered dialysis. These advantages include improved quality of life, less travel, and fewer dietary restrictions. Despite the benefits, home-based dialysis therapies are significantly underutilized by First Nations with only 16.2% uptake versus 25.7% uptake in non-First Nations people in Saskatchewan. It is important to recognize that First Nations have a greater burden of end-stage renal disease including higher prevalence, younger age at diagnosis, increased severity of disease, mortality at an earlier age, and increased travel distance to access kidney services. Objective: The goal of this study is to identify the existing barriers to home peritoneal dialysis and provide insight for future programs in Saskatchewan First Nations communities in a culturally meaningful framework. Design: Through qualitative research utilizing sharing circles and individual interviews, barriers to utilizing home-based dialysis were identified. Setting: Four sharing circles were held and interviews were conducted with four First Nations dialysis patients. Participants: Total number of participants in sharing circles were 67. Sharing circles were composed of patients with chronic kidney disease, patients on hospital-based dialysis, patients on home-based peritoneal dialysis, family members, health care providers (nurses, physicians, dietitians, primary care director, and coordinators). Face-to-face interviews were conducted with four First Nations dialysis patients. Measurements: The data from the sharing circles and interviews were transcribed and analyzed by a PhD researcher using constructivist grounded theory, with elements of narrative inquiry to ascertain participants’ experiences of care. Data were coded and then grouped into categories using qualitative research software NVivo. Saturation of data was achieved. Methods: Documenting and recounting patient and community experience with chronic kidney disease through sharing circles involving patients, family members, and health care providers has been the central information base for this project. Qualitative interviews were conducted with patients who currently use home dialysis and those who travel to hospital for dialysis. Written consent was obtained from all participants. Information was gathered via audio recording of all sharing circles and interviews. Transcription of the interviews was completed with confidentiality maintained during transcription. Results: The main theme of our results was addressing the underutilization of home-based peritoneal dialysis in First Nations Communities. Five subthemes emerged from the main theme and included logistics, education and information, training and support, community support, and culture and leadership. Through sharing circles, a secondary theme of observations about living with chronic kidney disease and experiences of being on dialysis was explored. Limitations: A small number of First Nations communities were involved in this project, and although the data reached saturation, we cannot presume that the information is representative of all First Nations in Saskatchewan. There were a limited number of patients currently on home-based peritoneal dialysis, and therefore their perceptions may not be adequately captured. Participant characteristics (patient, caregiver, nurse, etc) were not captured when speaking in the sharing circles, and therefore participants are not classified when quoted. Conclusions: Strategies to help improve home-based dialysis included improved education, local support, integrated traditional medicine, cultural sensitivity, and leadership prioritization. Abrégé Contexte: La dialyse et les autres modalités de remplacement rénal sont offertes en centre ou au domicile du patient. La dialyse à domicile offre de nombreux avantages comparativement à la dialyse en centre, notamment une meilleure qualité de vie, et requiert moins de déplacements et de restrictions alimentaires. Néanmoins, cette modalité continue d’être sous-utilisée par les patients autochtones en Saskatchewan (16,2 % contre 25,7 % dans la population allochtone). Il convient de souligner que le fardeau de l’insuffisance rénale terminale est plus important chez les patients autochtones: prévalence plus élevée, diagnostic et mortalité plus précoces, sévérité accrue de la maladie et distances plus grandes à parcourir pour accéder aux services néphrologiques. Objectifs: L’étude vise à recenser les facteurs limitant l’adoption de la dialyse péritonéale à domicile comme modalité, et à fournir un aper?u des programmes à venir dans les communautés des Premières Nations de la Saskatchewan dans un cadre culturellement significatif. Type d’étude: Nous avons recensé les obstacles au choix de la dialyse à domicile comme modalité de traitement par l’entremise d’une recherche
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机译：英语法语背景：肾置换选项或透析可在家庭环境或医院环境中提供。家庭透析提供了许多在医院交付的透析中的益处。这些优势包括改善的生活质量，较少的旅行，饮食限制较少。尽管有益处，但家庭透析疗法仍由第一个国家显着未充分利用，只有16.2％的摄取与萨斯喀彻温省的非第一国家人民的摄取量增加了25.7％。重要的是要认识到，第一国有更大的末期肾病负担，包括更高的患病率，诊断年龄较小，疾病严重程度，早期的死亡率，以及增加旅行距离以获得肾脏服务。目的：本研究的目标是确定家庭腹膜透析的现有障碍，并在文化意义的框架中提供萨斯喀彻温省第一国社区的未来方案的见解。设计：通过利用共享圈和个人访谈的定性研究，确定了利用家庭透析的障碍。设置：举行四个共享圈，并进行了四个第一国家透析患者进行的面试。参与者：分享圈中的参与者总数为67.分享圈是由慢性肾病患者组成，患者在医院的透析患者，家庭腹膜透析，家庭成员，医疗保健提供者（护士，医生，营养师，初级保健总监和协调员）。用四个第一国家透析患者进行面对面的采访。测量：使用建构主义接地理论的PHD研究人员转录和分析来自共享圈和访谈的数据，具有叙述查询的要素，以确定参与者的护理经历。使用定性研究软件NVIVO进行编码，然后将数据分组为类别。实现数据的饱和度。方法：通过分享涉及患者，家庭成员和医疗保健提供者的圈子，记录和叙事患者和社区经验，涉及患者，家庭成员和医疗保健提供者是该项目的中央信息库。与目前使用家庭透析的患者以及那些前往医院进行透析的人进行定性访谈。从所有参与者获得书面同意。通过所有共享圈和访谈的音频录制收集信息。在转录期间维持的机密完成面试的转录完成。结果：我们结果的主要主题是在第一个国家社区解决家庭腹膜透析的未充分利用。从主题中出现的五个子项，包括物流，教育和信息，培训和支持，社区支持和文化和领导。通过分享圈，探讨了关于慢性肾病的观察的二级主题和在透析的经验。限制：少数第一国社区参与了这个项目，虽然数据达到了饱和度，但我们不能认为该信息代表萨斯喀彻温省的所有第一国家。目前在家庭腹膜透析有有限数量的患者，因此他们的看法可能无法充分捕获。在共享圈中说话时，未捕获参与者特征（患者，照顾者，护士等），因此当引用时，参与者不会被归类。结论：有助于提高家庭透析的策略包括改善教育，当地支持，综合传统医学，文化敏感性和领导优先级。 AbrégéContexte：La透析et les autresmodalitésde remplacement realln sont enaufttes en Center ou Au Domicile du患者。 La透析à住所offefrecilevantages比较àla透析en中心，Notamment Une MeilleureQualitédevie，et Reviert Moins dedéplacentsetet de限制性。 Néanmoins，CetteModalité继续d'tree sous-uteriséepar les患者autochtones en saskatchewan（16,2％contre 25,7％dans la种群汤匙）。 IL Snowient de Souligner Que Le Fardeau de L'InsuffisanceRénaleStaineest Plus重要的Chez Les患者Autochtones：PrévalencePlusÉlevée，诊断etortalalitélanprécoces，SévéritéCrécoces，SévéritéAccruede la Maladie Et距离加上兰西州帕西鲁尔浇筑accéderoux服务Néphologiques。幽默：l'étudeviseàreacens les les facteurs limente l'pastione de la透析p diaandàomicile@modalité，etàfournir un aper？u des课程àvenirdans lescommunautéssdesmenièresnats de la saskatchewan dans de la saskatchewan dans联合国Cadre Culturelement意义。类型d'étude：别艾尚休克障碍Au Choix de la透析à居住在Modalitédetraitementpar l'entremise d'Une recherche
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