Spatial burden and self-managed safety in peritoneal dialysis: a qualitative study based on semi-structured...

Area of Science:

• Nephrology
• Sociology of Health & Illness
• Environmental Psychology

Background:

• Peritoneal dialysis (PD) offers spatial flexibility over in-center hemodialysis.
• This flexibility shifts clinical responsibility to patients for managing infection control and logistics at home.
• Spatial factors like housing and cleanliness are crucial for PD sustainability but often overlooked in consultations.

Purpose of the Study:

• To investigate how patients evaluate and manage their physical environments for clinical safety during PD.
• To understand the concrete mechanisms patients use to ensure safety in non-institutional settings.

Main Methods:

• Qualitative study utilizing semi-structured interviews with 43 adult PD patients in South Korea.
• Exploration of participants' experiences and evaluations of various spaces concerning PD.
• Inductive thematic analysis of interview data.

Main Results:

• Patients perceive spaces as managed clinical sites, not static settings.
• Hospitals are seen as sites of delegated safety; homes become sites of internalized safety through patient reconfiguration.
• External spaces present a paradox: theoretical flexibility leads to risk assessment and self-imposed spatial narrowing due to environmental unpredictability.

Conclusions:

• Space is a central, active dimension of the peritoneal dialysis experience, not a neutral backdrop.
• Understanding patients' spatial perceptions and management is vital for effective PD education and patient-centered communication.
• Addressing spatial dynamics is crucial to align PD's practical application with its theoretical flexibility.