Examining Quality of Life Priorities of Older Adults on Hemodialysis: A Q-Methodology Study

<h2>Abstract</h2><h3>Rationale & Objective</h3> Older adults represent the fastest-growing demographic initiating hemodialysis (HD) in the United States. Compared to older adults who do not receive HD, they commonly report a lower quality of life (QOL). However, their perspectives on QOL are poorly understood. The objective of this study was to identify and characterize QOL priorities of older adults receiving HD. <h3>Study Design</h3> Cross-sectional study using Q-methodology. <h3>Setting & Participants</h3> Participants were recruited from dialysis centers in and around Durham, North Carolina. Each participant sorted 35 QOL statements by level of agreement (e.g., agree, disagree, or neutral). <b>Analytic Approach:</b> Factor analysis of the Q sorts was performed using PQ Method software. Factors were interpreted and described as QOL priorities. Demographic and clinical characteristics were summarized overall and by factors. <h3>Results</h3> Twenty-nine older adults were recruited with a mean age 76.2±5.6 years, median dialysis vintage of 3 (1-4.8) years, and 18 (62.1%) were women. Ten (34%) participants screened positive for frailty questionnaire responses and 16 (55.2%) participants reported using an assisted device. Factor analysis revealed 2 distinct QOL prioritization profiles: "Every-day Well-being" and "Safety and Security." "Everyday Well-being", defined by 16 Q sorts, represented a perspective that highly valued cognitive function (memory/thinking ability), spirituality, adequate pain control, and well-functioning dialysis access. "Safety and Security", defined by 11 Q sorts, represented a perspective that highly valued socioeconomic stability, including financial stability, access to reliable transportation, and safety. We observed no difference in age, dialysis vintage, and performance on cognitive, physical function, and frailty assessments between participants whose Q-sorts defined each prioritization profile. Limitations: cross-sectional design, confinement to one geographical region. <h3>Conclusions</h3> Using Q-methodology, we identified two dominant profiles of QOL priorities among older adults on HD. These findings highlight heterogeneity in what matters most to older adults on HD and the need for personalized, patient-centered approaches to evaluating and improving their QOL.