Patient and Health Care Provider Perspectives of Cognitive Difficulties in Dialysis

Abstract

Introduction: Cognitive impairments (CIs) are common among patients on dialysis, compromising functional capacity, decision-making, and quality of life. Previous work is dominated by quantitative studies, leaving the everyday experience of these impairments and their practical implications poorly understood. This qualitative study explored patients’ and providers’ perspectives on the lived experience of cognitive difficulties, impacts on daily living and care delivery, and associated needs. Methods: Semistructured interviews and focus groups were conducted with 29 patients on hemodialysis (HD) and 27 renal health care providers (HCPs), including nephrologists, renal nurses, and allied health professionals. Interview transcripts were analyzed using reflexive thematic analysis. Results: The following 6 themes emerged: (i) manifestation of cognitive difficulties, (ii) perceived risk factors, (iii) impacts, (iv) attitudes toward cognitive difficulties, (v) strategies to manage cognitive difficulties, and (vi) unmet needs. Participants acknowledged dialysis patients’ CIs across multiple domains that compromised independence, increased caregiving burden, and interfered with routine care. HCPs highlighted health and safety risks associated with CIs, whereas patients viewed these impairments with varied attitudes, including normalization and denial. Patients and providers employed diverse strategies to manage cognitive difficulties, and identified a need for societal awareness, social support, and guidelines and tools to assess and manage cognitive difficulties. Conclusion: CIs is a major issue in renal care that affects the well-being of patients and their families and complicates care provision. This study identified modifiable barriers at the individual and systemic levels to the identification and management of CIs in renal settings, suggesting potential targets for intervention.