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Abstract: TH-PO287

A Case Study of the Barriers to the Practice of Person-Centered Care within the Context of Hemodialysis Services

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Lewis, Rachel Anne, University of Calgary, Calgary, Alberta, Canada
  • Tonelli, Marcello, University of Calgary, Calgary, Alberta, Canada
Background

People dependent upon hemodialysis have a high illness and treatment burden. This can be accentuated by care delivery systems that are disease specific, episodic, process focused and fragmented. Person-centered care (PCC) has been shown to provide a number of benefits including: improved health outcomes; increased patient satisfaction; and a reduction in healthcare utilization. Although conceptually PCC is widely supported, its translation into practice is proving to be a challenge. This research explores stakeholder perspectives of how care is provided within hemodialysis services. It particularly focuses on factors that inhibit PCC.

Methods

A case study approach was used that included semi-structured interviews and observation of clinical encounters, including physician rounding. Data was coded inductively and categorized into emergent themes using Nvivo®. Interpretive description was used to analyse the data. A total of 48 people were interviewed: 20 patients, 5 family members, 9 nurses, 6 physicians, 5 managers and 3 social workers. 30 hours of observation were undertaken.

Results

Care was largely limited to the technical aspects of dialysis treatment and whilst there was evidence of PCC, this was episodic and specific to individual clinicians and/or patients. Patients did not perceive their care as individualized, were not involved in decisions regarding it and felt the staff did not have time to listen to their concerns. Nurses described an oppressive and stressful environment with a culture of bullying. The routinization of nursing care and micromanagement, reduced their autonomy and scope of practice. Physician scheduling required reviewing a large number of patients within a short time span; care was often limited to addressing immediate issues and physicians had some concerns regarding continuity. Many of the healthcare professionals alluded to the lack of multi-professional working.

Conclusion

A complex mix of individual, environmental and organizational barriers mitigate against the adoption and practice of PCC within hemodialysis services. In particular, how professionals' practised was often constrained by care processes aimed at meeting demand. This was accentuated by the absence of integrated work practices.

Funding

  • Other NIH Support