Fatigue and self-management strategies among patients with end-stage kidney disease (ESKD) receiving haemodialysis

: A prospective qualitative exploration conducted in the Sultanate of Oman

Abstract

Background: The most reported debilitating symptom among patients with end-stage kidney disease (ESKD) receiving haemodialysis is fatigue. Fatigue impacts upon daily living activities, social functioning and psychological wellbeing, leading to poor quality of life. Across the Gulf States, up to 85% of patients receiving haemodialysis have reported fatigue. Despite this substantial incidence, the level of assessment and clear guidance for managing fatigue among patients with ESKD remains very limited, particularly among Arab nations. The literature highlights the need for further investigative studies to explore patients’ perspectives on ESKD-related fatigue and potential self-management options, particularly for the specific requirements of patients living in the Gulf region.


Aim: To explore perspectives of fatigue and strategies for its self-management among patients with ESKD receiving haemodialysis in Oman, and to consider the supportive contributions of experienced healthcare providers (HCPs) in relation to optimal fatigue management.

Methodology: A qualitative exploratory study informed by symptom management theory. A total of 25 semi-structured interviews with patients and four focus group interviews with HCPs were conducted in two haemodialysis centres in Oman. All interviews were audiotaped and transcribed verbatim. Themes were identified using a thematic analysis approach.

Findings: Overarching themes and subthemes from patient interviews included (1) ‘Perspective on ESKD-related fatigue’ (‘inevitability of fatigue’, ‘contributors to physical and mental fatigue’ and ‘self-initiated fatigue management strategies’); and (2) ‘Preferences for optimal fatigue management’ (‘communication’, ‘resources’ and ‘education’). Findings from HCPs were summarised in one overarching theme: ‘Perspectives on patient-preferred fatigue management strategies’, including issues that hindered HCPs from implementing patients’ preferred management strategies.

Discussion: The experience of fatigue among patients receiving haemodialysis is not entirely clear because it is difficult to identify the contributing factors, as they are non-specific, multifactorial, and attributed to cultural background, beliefs and environment. Guidance provided by HCPs to address fatigue or encourage its management is limited and patients were generally left to utilise trial and error methods to find their own workable strategies. There is clearly an opportunity for staff within haemodialysis centres to assess patients for fatigue and provide supportive guidance that will assist patients in identifying meaningful strategies and measures in managing fatigue.
The study utilised the symptom management theory (SMT), which served as a useful framework in structuring the interview schedule, collecting the data, interpreting the study findings, and recommending future research in this area. SMT helps also to understand the interaction of the three components of symptom experience, which relates to patient’s perception, evaluation and response to fatigue.

Conclusion: Fatigue among patients receiving haemodialysis is a significant healthcare challenge. Healthcare services in Oman need to promote an enhanced patient-centred ethos to improve the daily functioning and quality of life of patients as they come to terms with the effects of ESKD, haemodialysis and fatigue. Services would benefit from a reconfiguration or re-focus to ensure meaningful therapeutic communication, timely person-centred support and greater health education and promotion information. This study suggested that policy and practice should focus on developing a guideline on the assessment and management of ESKD related fatigue. Furthermore, fatigue-related interventions should be tailored to patients’ specific needs within their sociocultural context to reduce physical and mental fatigue.

Date of Award	Jul 2022
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Ministry of Higher Education, Research and Innovation of Oman
Supervisor	Kevin Gormley (Supervisor), Helen Noble (Supervisor) & Olinda Santin (Supervisor)