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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2015  |  Volume : 26  |  Issue : 1  |  Page : 73-77
Exploring the opinion of hemodialysis patients about their dialysis unit

Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

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Date of Web Publication8-Jan-2015


Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects.

How to cite this article:
Donia AF, Elhadedy MA, El-Maghrabi HM, Abbas MH, Foda MA. Exploring the opinion of hemodialysis patients about their dialysis unit. Saudi J Kidney Dis Transpl 2015;26:73-7

How to cite this URL:
Donia AF, Elhadedy MA, El-Maghrabi HM, Abbas MH, Foda MA. Exploring the opinion of hemodialysis patients about their dialysis unit. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Dec 3];26:73-7. Available from: https://www.sjkdt.org/text.asp?2015/26/1/73/148741

   Introduction Top

Patients on hemodialysis (HD) are subjected to a number of physical and mental stresses. [1] In an ongoing study at our unit, depression was the most common psychological abnormality among HD patients, concurring with many other studies. [2],[3],[4] In addition, similar to other dialysis units, [5] our patients are in closer contact with nursing staff than with physicians during the greater part of the HD session. Physicians, therefore, might be unaware of some patient needs and problems. Furthermore, sympathy with the patients and proper patient- staff relationship, although of utmost importance, might need to be augmented by regular "assessment" of patient's satisfaction to uncover all patient needs, especially for those who are not easy to express themselves. To the best of our knowledge, there are no published studies on a measured assessment of satisfaction among the Egyptian HD patients. These observations stimulated us to assess our patients' opinion about the service provided at the unit, explore more deeply their concerns and uncover any reasons for their dissatisfaction or stress caused by the regulations in the unit and/or by its staff.

   Patients and Methods Top

Our HD unit has 89 patients who undergo three regular HD sessions/week distributed over two daily shifts (excluding one day-off per week). A questionnaire exploring the opinion of the patients relative to the service provided in the unit was prepared [Table 1]. Services provided by different staff members as well as issues related to ordering and housekeeping inside the unit were graded as bad, mediocre or excellent. In addition, there was space for those patients who would like to explain their opinion(s) in more details. The idea of the questionnaire was explained to the patients during the daily rounds. The questionnaire, in addition to an envelope, was provided to the patients. The patients were asked to fillin the questionnaire privately, enclose it in the envelope and then put the sealed envelope in a common pool for collection. Illiterate patients were advised to fill-in the questionnaire with the help of a close relative at home and bring the closed envelope to the unit on the next session. It was stressed upon the participants that the questionnaire did not include a place for patient name, that all staff members will be blind regarding the patient identity while evaluating his/her opinion unless he/she opted to declare it and that the opinions will be taken globally and not on an individual basis. The above-mentioned information was stressed upon in order to encourage patients who would like to criticize the unit and/or one of the staff members to do so freely, without being worried about any possible bias or improper dealing by the staff in the future. SPSS program (version 17.0 for windows) was used to assess the internal consistency of the questionnaire via calculating its Cronbach's alfa.
Table 1: Results of the questionnaire about the patient's opinion regarding the dialysis unit

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   Results Top

Cronbach's alfa for the questionnaire was 0.773. Only 49 patients (55%) initially responded to the questionnaire. The number increased to 69 patients (77.5%) after a second call for the questionnaire. After collection of all questionnaires, they were analyzed using simple statistical methods. [Table 1] shows the results of the questionnaire. Overall, the responding patients gave a total of 563, 85, 37 and 5 excellent, mediocre, no comment and bad marks, respectively. Eight patients (11.6%) revealed their name on the questionnaire. Catering had the least percentage (68%) of evaluation as "excellent." Therefore, opinion on food supplied was further evaluated via direct interrogation with every patient. Thirty-five patients (50.7%) added further comments. Many of them were in the form of appreciation and encouragement. [Table 2] shows a summary of the negative impressions of the respondents. The same comment was sometimes reported by more than one patient (up to three). Individualization of the complaint (making complaint against a specific staff) was reported in two questionnaires. An audit meeting including the entire staff members of the HD unit was conducted. The results of the questionnaire were discussed. It was agreed upon to solve the maximum possible number of patient concerns and to regularly explore the patient opinions in a formal questionnaire every six months, in addition to the regular rounds and meetings.
Table 2: Summary of patients' negative impressions.

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   Discussion Top

At our HD unit, there is a daily round performed by the nephrology resident along with the specialist and/or the consultant. This might take about two hours per dialysis shift. The round takes a longer time if there is a new issue (e.g. access problem) and at the start of every month in order to review the monthly labs and update the management of each patient. After finishing the round, the physicians remain in the unit to take care of some issues related to the round, reply to calls from the nurses or patients and/or being indulged in teaching and research activities. However, we noticed that during the greater part of the session, the patient is in closer contact with the nursing staff. Many patients express their needs or complaints during the daily round, call for the doctor during the session or meet him after the session. Nevertheless, we thought that this would be insufficient to explore all the needs and concerns of the patients. In addition, the patient may feel embarrassed to express his/her complaint in front of the staff members.

The patient-doctor relationship might be affected by cultural and social issues. In Egypt, the patient frequently delegates his doctor to take the medical decision on his behalf. [6] This could be, in part, due to a high degree of trust. Nevertheless, Egypt nowadays is experiencing a new era and realizing how crucial it is to explore the opinion of apparently satisfied people. Unfortunately, assessment of patient satisfaction is not performed routinely in many health-care institutions. [7]

About one quarter of our patients did not reply to the questionnaire, concurring with an Italian study. [7] Our patients seldom evaluated the service as "bad," similar to an Irish study that reported high patient satisfaction with inter-personal care (83-98% satisfaction). [8]

This finding hopefully reflects a service that is acceptable for our patients. It might also be due to some hesitancy among our patients to express their criticism or due to the form of the questionnaire itself. A wider scale of assessment, e.g. 1 to 7 scale, [9] might be more informative Performance of doctors got the highest percentage of "excellent" evaluation, which may be partly due to lesser contact with the patient in contrast to other staff members. [5]

About half of our patients showed further comments in addition to responding to the standard questionnaire items. Development of a locally adjusted taxonomy and rating of importance of different aspects of care from our patients' perspective similar to that performed in the CHOICE study [10] may be helpful in making more objective questionnaires in the future. Dietary services had the lowest patient satisfaction score in our study, in contrast to another study [8] that showed that dietary services were one of the most satisfactory services (92-95%). The provision of an especially dedicated dietician might be one of our future solutions to improve this service. In conclusion, exploring the opinion of HD patients might uncover some areas of dissatisfaction thus helping to improve the provided service. It might also have a good psychological impact on patients. In addition, it gives the patients an opportunity to express their appreciation to the staff members, providing them with encouragement. We recommend widespread usage of informative questionnairs measuring patient satisfaction as well as assessing other health-care aspects such as patient education and compliance to treatment in order to keep an interactive link between patients and their care providers.

Conflict of interest: None

   References Top

Ginieri-Coccossis M, Theofilou P, Synodinou C, Tomaras V, Soldatos C. Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: Investigating differences in early and later years of current treatment. BMC Nephrol 2008;9:14.  Back to cited text no. 1
Cukor D, Rosenthal DS, Jindal RM, Brown CD, Kimmel PL. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int 2009;75:1223-9.  Back to cited text no. 2
Lopes AA, Albert JM, Young EW, et al. Screening for depression in hemodialysis patients: Associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney Int 2004;66:2047-53.  Back to cited text no. 3
Hedayati SS, Bosworth HB, Kuchibhatla M, Kimmel PL, Szczech LA. The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients. Kidney Int 2006;69:1662-8.  Back to cited text no. 4
Niedźwiecka A, Nowicki M, Tkaczyk M. Chronic dialysis patients' expectations towards dialysis nurses. Pol Merkur Lekarski 2009;26:311-4.  Back to cited text no. 5
Donia AF, Ammar HM, Elbaz A, El-Husseini FM, Sobh MA. Long-term efficacy of two unconventional adjunctive therapies in minimal change nephrotic children. Pediatr Nephrol 2005;20:1420-5.  Back to cited text no. 6
Pansini F, Gargano L, Sambati M, et al. Patient satisfaction in hemodialysis: A pilot crosssectional analysis and a review. G Ital Nefrol 2007;24:584-94.  Back to cited text no. 7
Rundle K, Keegan O, McGee HM. Patients' experiences of dialysis services: Are national health strategy targets being met? Ir J Med Sci 2004;173:78-81.  Back to cited text no. 8
Fadem SZ, Walker DR, Abbott G, et al. Satisfaction with renal replacement therapy and education: The American Association of Kidney Patients survey. Clin J Am Soc Nephrol 2011;6:605-12.  Back to cited text no. 9
Rubin HR, Jenckes M, Fink NE, et al. Patient's view of dialysis care: Development of a taxonomy and rating of importance of different aspects of care. CHOICE study. Choices for Healthy Outcomes in Caring for ESRD. Am J Kidney Dis 1997;30:793-801.  Back to cited text no. 10

Correspondence Address:
Dr. Ahmed Farouk Donia
Urology and Nephrology Center, Mansoura University, Mansoura
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DOI: 10.4103/1319-2442.148741

PMID: 25579719

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