Abstract

Rationale & ObjectiveAlmost all dialysis patients experience polypharmacy but little is known about their experiences with medication or perceptions towards it. In this qualitative study, we aimed to gain insight into dialysis patients’ experiences with polypharmacy, the ways they integrate their medication into their daily lives, and the ways it affects their quality of life. Study DesignQualitative study using semi-structured interviews. Setting & ParticipantsDialysis patients from two Dutch university hospitals. Analytical ApproachInterviews were transcribed verbatim and analysed independently by two researchers through thematic content analysis. ResultsOverall, 28 participants were interviewed (29% women, mean age 63±16 years, median dialysis vintage 25.5 [IQR 15-48] months, mean daily number of medications 10±3). Important themes were (1) participants’ own definition of what constitutes ‘medication’, (2) their perception of medication, (3) medication routines and their impact on daily (quality of) life, and (4) interactions with healthcare professionals and others regarding medication. Participants generally perceived medication as burdensome but less so than dialysis. Medication was accepted as an essential precondition for their health even though participants did not always notice these health benefits directly. Medication routines and other coping mechanisms helped participants reduce the perceived negative effects of medication. In fact, medication increased freedom for some participants. Participants generally had constructive relationships with their physicians when discussing their medication. LimitationsResults are context dependent and might therefore not apply directly to other contexts. ConclusionsPolypharmacy negatively affected dialysis patients’ quality of life, but these effects were overshadowed by the burden of dialysis. The patients’ realization that medication is important to their health and effective coping strategies mitigated the negative impact of polypharmacy on their quality of life. Physicians and patients should work together continuously to evaluate the impact of treatments on health and other aspects of patients’ daily lives.

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