A Study On The Current Situation And Influencing Factors Of Palliative Care Needs In Older Patients With Maintenance Hemodialysis

ObjectivesTo investigate the current situation and influencing factors of palliative care needs in older patients with end-stage renal disease undergoing maintenance hemodialysis(MHD).MethodsThis study adopted the mixed method of convergent design,and carried out quantitative research and qualitative research simultaneously.1.Quantitative study:225 older MHD patients from February 2022 to December 2022 in blood purification centers of two tertiary hospitals were selected by a cross-sectional survey method with convenience sampling.The General Information Questionnaire,Palliative Care Outcome Scale(POS),Dialysis Frequency,Severity,and Symptom Burden Index(DFSSBI),Social Support Rate Scale(SSRS),Patient Health Questionnaire-9 item(PHQ-9)and Karnofsky Performance Status Scale(KPS)were used to collect data.Wilcoxon rank-sum test,Kruskal-Wallis H test,Pearson correlation analysis,and multiple linear regression analysis were used to analyze data.2.Qualitative study:A descriptive qualitative study was conducted with a purposive sampling of 45 older MHD patients as interviewees from February 2022 to December 2022 in blood purification centers of two tertiary hospitals,and data were collected by semi-structured interview method and analyzed by directed content analysis methodResults1.Quantitative study:The median score for palliative care needs in older MHD patients was 18.0(13.0,24.0),with the highest score being family anxiety,and other high scores being information needs,practical problems,control of other symptoms,level of support,time consuming,etc.Multivariate results showed that average monthly family income,symptom burden,functional status,depressive mood and social support level were influencing factors of palliative care needs in older MHD patients(P<0.05),accounting for 79.3%of the total variation in palliative care needs.2.Qualitative study The results generated a total of 2 themes and 9 sub-themes.Theme 1 was the specific content of palliative care needs of older MHD patients,including 5 sub-themes,which were symptom management needs,information needs,social needs,spiritual needs and practical needs.Theme 2 was the reasons for unmet needs of older MHD patients,including 4 sub-themes,which were individual level factors,interpersonal level factors,organizational level factors and policy level factors.ConclusionsThis study found a higher level of palliative care needs in older MHD patients.The specific content of needs included physiological needs,psychological needs,information needs,social needs,spiritual needs and practical needs,and the unmet needs were mainly affected by individual,interpersonal,organizational and policy factors.It suggests that an interdisciplinary palliative care team should be established in the future,to provide comprehensive care services for patients from a holistic perspective,so as to improve their quality of life.