Living with haemodialysis in Sri Lanka: a qualitative study on patient adaptation and care perceptions

The increasing prevalence of individuals undergoing haemodialysis (HD) compels the necessity of person-centred care to minimise treatment-related complications and improve the quality of life. Although the person-centred approach has been widely discussed, it remains underutilised in HD care, particularly in low- to middle-income countries. Understanding how patients perceive their care is crucial for developing tailored interventions and achieving desirable health outcomes. Therefore, this study was aimed to explore patients’ experiences of HD care in three selected government hospital dialysis units in Colombo District, Sri Lanka. One-to-one, semi-structured interviews were conducted with a purposive sample of twelve participants undergoing HD for more than six consecutive months and receiving at least one dialysis session per week. Interviews were conducted from April to December 2022 until data saturation was reached. All interviews were digitally recorded, transcribed verbatim and analysed using the qualitative content analysis proposed by Graneheim and Lundman. An overarching theme, ‘Adapting to a Disrupted Life Trajectory’ with four categories emerged: Burden of living with HD, Physical and psychological consequences of treatment, Coping and adjustment mechanisms, Healthcare system and service experiences. Daily life was often a burden for the participants due to physical and psychological challenges, numerous life restrictions and self-care burden. Despite these altered life routines, patients adapted coping mechanisms to regain a sense of control and maintain continuity of their treatment. Stigma associated with the terminal illness, famiy dynamics, and internal coping through spirituality shaped unique patient adaptation to the illness experience. Participants expressed a need for accessible HD care that is high in quality, safe, and delivered with compassion. A person-centred approach, including goals of care conversations, would help to address patients’ concerns related to the multifaceted burden of HD treatment. Strengthening a well-coordinated, multidisciplinary team including nephrology, palliative care, and community-based services is essential to meet patients’ complex needs and provide specialist support across physical, psychological, social, and spiritual domains during the illness trajectory in a more holistic and timely manner.