Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers
Abstract Background While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-ma...
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| Veröffentlicht in: | Nephrology, dialysis, transplantation dialysis, transplantation, 2020-11, Vol.35 (11), p.1949-1958 |
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| container_end_page | 1958 |
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| container_issue | 11 |
| container_start_page | 1949 |
| container_title | Nephrology, dialysis, transplantation |
| container_volume | 35 |
| creator | Baumgart, Amanda Manera, Karine E Johnson, David W Craig, Jonathan C Shen, Jenny I Ruiz, Lorena Wang, Angela Yee-Moon Yip, Terence Fung, Samuel K S Tong, Matthew Lee, Achilles Cho, Yeoungjee Viecelli, Andrea K Sautenet, Benedicte Teixeira-Pinto, Armando Brown, Edwina A Brunier, Gillian Dong, Jie Scholes-Robertson, Nicole Dunning, Tony Mehrotra, Rajnish Naicker, Saraladevi Pecoits-Filho, Roberto Perl, Jeffrey Wilkie, Martin Tong, Allison |
| description | Abstract
Background
While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients’ and caregivers’ perspectives on the meaning and role of patient empowerment in PD.
Methods
Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed.
Results
We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen).
Conclusions
Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD. |
| doi_str_mv | 10.1093/ndt/gfaa127 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7824999</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ndt/gfaa127</oup_id><sourcerecordid>2427525234</sourcerecordid><originalsourceid>FETCH-LOGICAL-c412t-283bdcf08ff5a71dd6095e8420554c3a6e9ba619b8df58cde62bf09acec315253</originalsourceid><addsrcrecordid>eNp9kcFrFjEQxYMo9rN68i45iSBrk-xmd-NBkGJVaOmlgrcwm0y2kd1kTXZb-t838n0tevE0h_nNe495hLzm7ANnqj4Jdj0ZHQAX3ROy403LKlH38inZlS2vmGTqiLzI-RdjTImue06OatFx0XZiR35eIAQfRhodxXmJt5hmDCv1gS6Y_BoDwkSth-ku-_yRumi2TMcUtyXTW79e0wVWXy4yhWCpgYSjv8GUX5JnDqaMrw7zmPw4-3J1-q06v_z6_fTzeWUaLtZK9PVgjWO9cxI6bm3LlMS-EUzKxtTQohqg5WrorZO9sdiKwTEFBk3NpZD1Mfm01122YUZrSpQEk16SnyHd6Qhe_7sJ_lqP8UZ3vWiUUkXg3UEgxd8b5lXPPhucJggYt6xFI7piJOqmoO_3qEkx54Tu0YYz_acLXbrQhy4K_ebvZI_sw_ML8HYPlGf-V-keJByWJQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2427525234</pqid></control><display><type>article</type><title>Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Baumgart, Amanda ; Manera, Karine E ; Johnson, David W ; Craig, Jonathan C ; Shen, Jenny I ; Ruiz, Lorena ; Wang, Angela Yee-Moon ; Yip, Terence ; Fung, Samuel K S ; Tong, Matthew ; Lee, Achilles ; Cho, Yeoungjee ; Viecelli, Andrea K ; Sautenet, Benedicte ; Teixeira-Pinto, Armando ; Brown, Edwina A ; Brunier, Gillian ; Dong, Jie ; Scholes-Robertson, Nicole ; Dunning, Tony ; Mehrotra, Rajnish ; Naicker, Saraladevi ; Pecoits-Filho, Roberto ; Perl, Jeffrey ; Wilkie, Martin ; Tong, Allison</creator><creatorcontrib>Baumgart, Amanda ; Manera, Karine E ; Johnson, David W ; Craig, Jonathan C ; Shen, Jenny I ; Ruiz, Lorena ; Wang, Angela Yee-Moon ; Yip, Terence ; Fung, Samuel K S ; Tong, Matthew ; Lee, Achilles ; Cho, Yeoungjee ; Viecelli, Andrea K ; Sautenet, Benedicte ; Teixeira-Pinto, Armando ; Brown, Edwina A ; Brunier, Gillian ; Dong, Jie ; Scholes-Robertson, Nicole ; Dunning, Tony ; Mehrotra, Rajnish ; Naicker, Saraladevi ; Pecoits-Filho, Roberto ; Perl, Jeffrey ; Wilkie, Martin ; Tong, Allison</creatorcontrib><description>Abstract
Background
While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients’ and caregivers’ perspectives on the meaning and role of patient empowerment in PD.
Methods
Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed.
Results
We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen).
Conclusions
Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.</description><identifier>ISSN: 0931-0509</identifier><identifier>EISSN: 1460-2385</identifier><identifier>DOI: 10.1093/ndt/gfaa127</identifier><identifier>PMID: 32712672</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Caregivers - psychology ; Female ; Focus Groups ; Humans ; Life Style ; Male ; Middle Aged ; Original ; Patient Participation - methods ; Patient Participation - psychology ; Peritoneal Dialysis - psychology ; Self-Management - methods ; Self-Management - psychology ; Treatment Outcome ; Young Adult</subject><ispartof>Nephrology, dialysis, transplantation, 2020-11, Vol.35 (11), p.1949-1958</ispartof><rights>The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. 2020</rights><rights>The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-283bdcf08ff5a71dd6095e8420554c3a6e9ba619b8df58cde62bf09acec315253</citedby><cites>FETCH-LOGICAL-c412t-283bdcf08ff5a71dd6095e8420554c3a6e9ba619b8df58cde62bf09acec315253</cites><orcidid>0000-0001-8260-0453 ; 0000-0002-0552-6074</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1583,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32712672$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baumgart, Amanda</creatorcontrib><creatorcontrib>Manera, Karine E</creatorcontrib><creatorcontrib>Johnson, David W</creatorcontrib><creatorcontrib>Craig, Jonathan C</creatorcontrib><creatorcontrib>Shen, Jenny I</creatorcontrib><creatorcontrib>Ruiz, Lorena</creatorcontrib><creatorcontrib>Wang, Angela Yee-Moon</creatorcontrib><creatorcontrib>Yip, Terence</creatorcontrib><creatorcontrib>Fung, Samuel K S</creatorcontrib><creatorcontrib>Tong, Matthew</creatorcontrib><creatorcontrib>Lee, Achilles</creatorcontrib><creatorcontrib>Cho, Yeoungjee</creatorcontrib><creatorcontrib>Viecelli, Andrea K</creatorcontrib><creatorcontrib>Sautenet, Benedicte</creatorcontrib><creatorcontrib>Teixeira-Pinto, Armando</creatorcontrib><creatorcontrib>Brown, Edwina A</creatorcontrib><creatorcontrib>Brunier, Gillian</creatorcontrib><creatorcontrib>Dong, Jie</creatorcontrib><creatorcontrib>Scholes-Robertson, Nicole</creatorcontrib><creatorcontrib>Dunning, Tony</creatorcontrib><creatorcontrib>Mehrotra, Rajnish</creatorcontrib><creatorcontrib>Naicker, Saraladevi</creatorcontrib><creatorcontrib>Pecoits-Filho, Roberto</creatorcontrib><creatorcontrib>Perl, Jeffrey</creatorcontrib><creatorcontrib>Wilkie, Martin</creatorcontrib><creatorcontrib>Tong, Allison</creatorcontrib><title>Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers</title><title>Nephrology, dialysis, transplantation</title><addtitle>Nephrol Dial Transplant</addtitle><description>Abstract
Background
While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients’ and caregivers’ perspectives on the meaning and role of patient empowerment in PD.
Methods
Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed.
Results
We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen).
Conclusions
Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Caregivers - psychology</subject><subject>Female</subject><subject>Focus Groups</subject><subject>Humans</subject><subject>Life Style</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Patient Participation - methods</subject><subject>Patient Participation - psychology</subject><subject>Peritoneal Dialysis - psychology</subject><subject>Self-Management - methods</subject><subject>Self-Management - psychology</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0931-0509</issn><issn>1460-2385</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFrFjEQxYMo9rN68i45iSBrk-xmd-NBkGJVaOmlgrcwm0y2kd1kTXZb-t838n0tevE0h_nNe495hLzm7ANnqj4Jdj0ZHQAX3ROy403LKlH38inZlS2vmGTqiLzI-RdjTImue06OatFx0XZiR35eIAQfRhodxXmJt5hmDCv1gS6Y_BoDwkSth-ku-_yRumi2TMcUtyXTW79e0wVWXy4yhWCpgYSjv8GUX5JnDqaMrw7zmPw4-3J1-q06v_z6_fTzeWUaLtZK9PVgjWO9cxI6bm3LlMS-EUzKxtTQohqg5WrorZO9sdiKwTEFBk3NpZD1Mfm01122YUZrSpQEk16SnyHd6Qhe_7sJ_lqP8UZ3vWiUUkXg3UEgxd8b5lXPPhucJggYt6xFI7piJOqmoO_3qEkx54Tu0YYz_acLXbrQhy4K_ebvZI_sw_ML8HYPlGf-V-keJByWJQ</recordid><startdate>20201101</startdate><enddate>20201101</enddate><creator>Baumgart, Amanda</creator><creator>Manera, Karine E</creator><creator>Johnson, David W</creator><creator>Craig, Jonathan C</creator><creator>Shen, Jenny I</creator><creator>Ruiz, Lorena</creator><creator>Wang, Angela Yee-Moon</creator><creator>Yip, Terence</creator><creator>Fung, Samuel K S</creator><creator>Tong, Matthew</creator><creator>Lee, Achilles</creator><creator>Cho, Yeoungjee</creator><creator>Viecelli, Andrea K</creator><creator>Sautenet, Benedicte</creator><creator>Teixeira-Pinto, Armando</creator><creator>Brown, Edwina A</creator><creator>Brunier, Gillian</creator><creator>Dong, Jie</creator><creator>Scholes-Robertson, Nicole</creator><creator>Dunning, Tony</creator><creator>Mehrotra, Rajnish</creator><creator>Naicker, Saraladevi</creator><creator>Pecoits-Filho, Roberto</creator><creator>Perl, Jeffrey</creator><creator>Wilkie, Martin</creator><creator>Tong, Allison</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8260-0453</orcidid><orcidid>https://orcid.org/0000-0002-0552-6074</orcidid></search><sort><creationdate>20201101</creationdate><title>Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers</title><author>Baumgart, Amanda ; Manera, Karine E ; Johnson, David W ; Craig, Jonathan C ; Shen, Jenny I ; Ruiz, Lorena ; Wang, Angela Yee-Moon ; Yip, Terence ; Fung, Samuel K S ; Tong, Matthew ; Lee, Achilles ; Cho, Yeoungjee ; Viecelli, Andrea K ; Sautenet, Benedicte ; Teixeira-Pinto, Armando ; Brown, Edwina A ; Brunier, Gillian ; Dong, Jie ; Scholes-Robertson, Nicole ; Dunning, Tony ; Mehrotra, Rajnish ; Naicker, Saraladevi ; Pecoits-Filho, Roberto ; Perl, Jeffrey ; Wilkie, Martin ; Tong, Allison</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-283bdcf08ff5a71dd6095e8420554c3a6e9ba619b8df58cde62bf09acec315253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Caregivers - psychology</topic><topic>Female</topic><topic>Focus Groups</topic><topic>Humans</topic><topic>Life Style</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Patient Participation - methods</topic><topic>Patient Participation - psychology</topic><topic>Peritoneal Dialysis - psychology</topic><topic>Self-Management - methods</topic><topic>Self-Management - psychology</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baumgart, Amanda</creatorcontrib><creatorcontrib>Manera, Karine E</creatorcontrib><creatorcontrib>Johnson, David W</creatorcontrib><creatorcontrib>Craig, Jonathan C</creatorcontrib><creatorcontrib>Shen, Jenny I</creatorcontrib><creatorcontrib>Ruiz, Lorena</creatorcontrib><creatorcontrib>Wang, Angela Yee-Moon</creatorcontrib><creatorcontrib>Yip, Terence</creatorcontrib><creatorcontrib>Fung, Samuel K S</creatorcontrib><creatorcontrib>Tong, Matthew</creatorcontrib><creatorcontrib>Lee, Achilles</creatorcontrib><creatorcontrib>Cho, Yeoungjee</creatorcontrib><creatorcontrib>Viecelli, Andrea K</creatorcontrib><creatorcontrib>Sautenet, Benedicte</creatorcontrib><creatorcontrib>Teixeira-Pinto, Armando</creatorcontrib><creatorcontrib>Brown, Edwina A</creatorcontrib><creatorcontrib>Brunier, Gillian</creatorcontrib><creatorcontrib>Dong, Jie</creatorcontrib><creatorcontrib>Scholes-Robertson, Nicole</creatorcontrib><creatorcontrib>Dunning, Tony</creatorcontrib><creatorcontrib>Mehrotra, Rajnish</creatorcontrib><creatorcontrib>Naicker, Saraladevi</creatorcontrib><creatorcontrib>Pecoits-Filho, Roberto</creatorcontrib><creatorcontrib>Perl, Jeffrey</creatorcontrib><creatorcontrib>Wilkie, Martin</creatorcontrib><creatorcontrib>Tong, Allison</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Nephrology, dialysis, transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baumgart, Amanda</au><au>Manera, Karine E</au><au>Johnson, David W</au><au>Craig, Jonathan C</au><au>Shen, Jenny I</au><au>Ruiz, Lorena</au><au>Wang, Angela Yee-Moon</au><au>Yip, Terence</au><au>Fung, Samuel K S</au><au>Tong, Matthew</au><au>Lee, Achilles</au><au>Cho, Yeoungjee</au><au>Viecelli, Andrea K</au><au>Sautenet, Benedicte</au><au>Teixeira-Pinto, Armando</au><au>Brown, Edwina A</au><au>Brunier, Gillian</au><au>Dong, Jie</au><au>Scholes-Robertson, Nicole</au><au>Dunning, Tony</au><au>Mehrotra, Rajnish</au><au>Naicker, Saraladevi</au><au>Pecoits-Filho, Roberto</au><au>Perl, Jeffrey</au><au>Wilkie, Martin</au><au>Tong, Allison</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers</atitle><jtitle>Nephrology, dialysis, transplantation</jtitle><addtitle>Nephrol Dial Transplant</addtitle><date>2020-11-01</date><risdate>2020</risdate><volume>35</volume><issue>11</issue><spage>1949</spage><epage>1958</epage><pages>1949-1958</pages><issn>0931-0509</issn><eissn>1460-2385</eissn><abstract>Abstract
Background
While peritoneal dialysis (PD) can offer patients more independence and flexibility compared with in-center hemodialysis, managing the ongoing and technically demanding regimen can impose a burden on patients and caregivers. Patient empowerment can strengthen capacity for self-management and improve treatment outcomes. We aimed to describe patients’ and caregivers’ perspectives on the meaning and role of patient empowerment in PD.
Methods
Adult patients receiving PD (n = 81) and their caregivers (n = 45), purposively sampled from nine dialysis units in Australia, Hong Kong and the USA, participated in 14 focus groups. Transcripts were thematically analyzed.
Results
We identified six themes: lacking clarity for self-management (limited understanding of rationale behind necessary restrictions, muddled by conflicting information); PD regimen restricting flexibility and freedom (burden in budgeting time, confined to be close to home); strength with supportive relationships (gaining reassurance with practical assistance, comforted by considerate health professionals, supported by family and friends); defying constraints (reclaiming the day, undeterred by treatment, refusing to be defined by illness); regaining lost vitality (enabling physical functioning, restoring energy for life participation); and personal growth through adjustment (building resilience and enabling positive outlook, accepting the dialysis regimen).
Conclusions
Understanding the rationale behind lifestyle restrictions, practical assistance and family support in managing PD promoted patient empowerment, whereas being constrained in time and capacity for life participation outside the home undermined it. Education, counseling and strategies to minimize the disruption and burden of PD may enhance satisfaction and outcomes in patients requiring PD.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>32712672</pmid><doi>10.1093/ndt/gfaa127</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8260-0453</orcidid><orcidid>https://orcid.org/0000-0002-0552-6074</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0931-0509 |
| ispartof | Nephrology, dialysis, transplantation, 2020-11, Vol.35 (11), p.1949-1958 |
| issn | 0931-0509 1460-2385 |
| language | eng |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult Aged Aged, 80 and over Caregivers - psychology Female Focus Groups Humans Life Style Male Middle Aged Original Patient Participation - methods Patient Participation - psychology Peritoneal Dialysis - psychology Self-Management - methods Self-Management - psychology Treatment Outcome Young Adult |
| title | Meaning of empowerment in peritoneal dialysis: focus groups with patients and caregivers |
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