DIALYSIS PATIENTS' PERCEPTION OF PERITONEAL DIALYSIS IN SINGAPORE

Abstract

Background: Little is understood about the perceptions and characteristics of dialysis patients in Singapore. There is an increasing trend of patients diagnosed with end-stage renal disease (ESRD), of which the dominant treatment option is dialysis. Haemodialysis (HD) is preferred, and there is a disproportionately low proportion of patients who choose peritoneal dialysis (PD). The patient's family, other patients and healthcare professionals, together with structural factors, influence perceptions and hence decision-making on choice of dialysis modality. Literature comparing PD and HD has found that PD has some advantages over HD. This exploratory study investigated the salient factors that shape the patient perceptions of PD.

Method: The Perceptions of Peritoneal Dialysis (PPD) questionnaire was developed. It consists of eight scales, including adaptations of the short version of the Mishel Uncertainty of Illness Scale and abbreviated version of the Connor-Davidson Resilience Scale. Content validity was tested with patients, medical social workers and nurses. Items with content validity index of less than 0.80 were re-examined based on feedback from the content experts. Reliability analysis of scales found good internal consistency for 5 out of 7 scales. The final PPD was completed by 89 incident dialysis patients in the National Kidney Foundation (NKF) between December 2016- February 2017.Verbal consent was obtained by NKF healthcare professionals before they administered the questionnaire. Participants' ages ranged from 25-68 years, with a mean age of 44.86 years (SD=1.06 ). The sample had been on dialysis for an average of slightly more than 10 months (SD=0.73), with the majority on HD (70.8%).

Results: Older patients were found to have lesser self-reported knowledge about PD and higher levels of perceived social support. Significant differences in uncertainty, perceived social support and attitudes towards PD were found between the different dialysis modality groups. HD patients had higher scores for uncertainty and reported higher levels of perceived social support. Better attitude towards PD was correlated with choosing PD. The relationship between resilience and social support was also tested. Resilience and social support were found to be positively correlated in this sample.

Conclusion: The results suggest that different perceptions of PD influence the patients' choice of dialysis modality. A holistic pre-dialysis education targeted at diabetic patients at-risk of developing ESRD is recommended. The role of the HCPs in reducing uncertainty for newly-diagnosed ESRD patients is also underscored. Finally, further research on how interpersonal and structural factors influence perceptions towards PD is proposed.