Self-management barriers in dialysis patients: a target for improving health outcomes

Adequate self-management behaviours may improve health outcomes, but dialysis patients often struggle to adopt and maintain these behaviours. Therefore, we aimed to 1) identify self-management barriers in dialysis patients, 2) assess their relation to patient characteristics, and 3) assess their effect on clinical and patient-reported outcomes.

We conducted a multicentre, longitudinal cohort study in adult incident dialysis patients who filled in the Self-Management Screening questionnaire. Descriptive analyses were performed to assess the extent of self-management barriers. The relation between patient characteristics and self-management barriers was determined using Spearman's rank correlation coefficient. The impact of self-management barriers on health outcomes was investigated using linear and Cox regression models.

In 1518 dialysis patients, self-management barriers were common across a wide range of domains (eg self-efficacy, coping, and social support). Sex, age, educational level, cohabitation, dialysis modality, and comorbidity were associated with the extent of individual self-management barriers and the total number of barriers. Moreover, a higher number of self-management barriers was associated with poorer mental and physical health-related quality of life, and with a higher symptom number and burden at 6 and 12 months after dialysis initiation.

Dialysis patients frequently experience self-management barriers across many domains and the extent differs depending on patient characteristics. Self-management barriers negatively impact patient-reported outcomes over time. Our findings highlight the importance of systematic, personalised, multicomponent self-management support in dialysis care, as this is an important target to improve health outcomes in this population.