Understanding patient lived experiences of hospital admission and aftercare following Acute Kidney Injury: A ‘Lifeworld’ perspective

Acute kidney injury (AKI) is a common, harmful and costly clinical syndrome with high rates of unplanned readmissions and poor long-term health outcomes. Recent understandings, expounded in the concept of 'Lifeworld', place the healthcare needs of patients within the wider context of their lives. We aimed to explore patients' lived experience of care following an AKI and healthcare professionals perspectives of the management of AKI and relational work in that context. We interviewed 26 patients from six hospitals who had recently had an admission affected by AKI; 11 patients participated in further follow up interviews. We conducted 6 focus groups at separate sites across England with a total of 35 healthcare professionals from secondary and primary care. A reflexive thematic analysis was undertaken of the personal holistic stories of patients leading to interpretation of themes, confirmed by detailed analysis of the health professional focus groups. We interpreted three themes from the interview and focus group data: 'Patient vulnerability: From hospital to the wider contexts of patients' lives; 'Understanding AKI in context: Challenges communicating kidney care'; 'Feeling lost and adrift: Challenges navigating follow-up care after AKI'. Patients expressed feelings of vulnerability, needing reassurances about their ongoing kidney health. Patients had little awareness of AKI, or clarity of how kidney aspects of care were integrated into wider ongoing management. Practitioners, researchers, educators and policy makers might reflect upon 'Lifeworld' care approaches, particularly within relational work in aftercare, and consider the complex contexts of patient subjective experience in which AKI may occur.