Patients' experiences of a dialysis diet and their implications for the role of the dietitian.
OBJECTIVE
Although developments in medical technology, pharmacology, and nutritional science continue to improve treatment possibilities for patients with renal failure, the level of compliance with medical and dietetic advice remains poor. Previous research on compliance with treatment of chronic illness has led to recommendations for an improved understanding of what is involved in living with chronic illness in order to tailor treatment more appropriately to individual needs. This qualitative study set out to examine, the experiences and difficulties of patients on hemodialysis who follow dietary restrictions, and to ascertain how the dietitian can most effectively support patients in adapting to dietary change.


DESIGN
A semi structured interview format with thematic analysis was chosen.


SETTING
The interviews took place in the patients' homes and lasted between 30 and 60 minutes.


PATIENTS
Participants for the study were approached at Taunton and Yeovil dialysis centres in Somerset, England, and were selected according to the following criteria: (1) all had been on hemodialysis for at least 6 months, (2) all had been advised to follow dietary and/or fluid restrictions at one time, and (3) none had any diagnosed intellectual impairment. Eight subjects were recruited, 4 men and 4 women. The age range was 20 to 68 years.


INTERVENTION
Participants were asked to describe in depth their experiences of renal failure and of a renal diet. They were asked what had helped them cope with the difficulties they had faced and how they saw the role of the dietitian.


OUTCOME MEASUREMENT
The interviews were recorded, transcribed, and coded according to the following categories: (1) Difficulties experienced by participants. (2) What helped them cope with these difficulties. (3) How the dietitian can help support the coping process.


RESULTS
Findings showed a variety of physical, social, and psychological difficulties that can result from the onset of illness, commencement of dialysis, and the imposition of dietary restrictions. A loss of autonomy was an underlying theme. Greater understanding, hope, support from others, individual activity, and personal responsibility on the part of patients helped them to cope more positively with the changes in life.


CONCLUSION
Recommendations from this research include ways by which the dietitian can encourage greater autonomy when advising patients, and how they can give information in a positive, sensitive, and supportive way.