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Abstract: SA-PO305

A "Best Fit" Framework Synthesis to Guide Adherence Interventions for Patients on Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Taylor, Kathryn, Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Umeukeje, Ebele M., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Santos, Sydney, Johns Hopkins University, Baltimore, Maryland, United States
  • Mcnabb, Katherine C., Johns Hopkins University School of Nursing, Baltimore, Maryland, United States
  • Crews, Deidra C., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Hladek, Melissa D., Johns Hopkins University School of Nursing, Baltimore, Maryland, United States

Patients with end-stage kidney disease (ESKD) treated with hemodialysis in the U.S. have higher rates of nonadherence compared to patients in other countries. Published adherence interventions demonstrate limited efficacy. Qualitative research that explores patient perspectives about adherence may point to gaps in existing interventions. The aim of this review was to synthesize qualitative data about adherence to hemodialysis treatment, medications, or fluid and dietary restrictions to inform development of patient-centered adherence interventions.


We conducted a “best fit” framework synthesis of qualitative studies on adherence to hemodialysis treatment, medications, and fluid and dietary restrictions. We searched PubMed, CINAHL, PsychInfo, Embase, and Web of Science for relevant literature. We analyzed qualitative data via thematic analysis, initially identifying codes from the World Health Organization’s adherence framework.


We screened 1775 articles and extracted qualitative data from 12. The data revealed 20 factors unique to hemodialysis treatment across the World Health Organization’s five dimensions of adherence. Two themes emerged from the data: (1) adherence in the context of patients’ whole lives and (2) dialysis treatment as a double-edged sword. Patients described a profound grieving process over loss of their “old self”. They navigated complex challenges as they balanced ESKD treatment, life tasks, and social roles.


One-size-fits-all approaches to improving adherence among patients on hemodialysis are inadequate. Adherence may improve when care incorporates patient context and provides ongoing support to patients and families as they navigate the logistical, physical, and psychological hardships of living with dialysis.


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