目的:土著人民承受着肾脏疾病的高负担。与接受类似治疗的非土著患者相比,接受维持性透析的患者的预后较差。我们描述了在英国殖民国家接受透析的土著患者的经历,以了解肾脏护理的哪些方面可能会从改善中受益。
方法:对已发表的定性访谈研究的系统综述。
方法:18岁及以上的原住民,在英国殖民国家接受血液透析或腹膜透析。
方法:土著人民搜索词,透析,定性研究进入MEDLINE,Embase,PsycINFO和CINAHL,并从开始到2023年1月5日进行搜索。
方法:将每项研究的特征提取到MicrosoftExcel中进行质量评估。
方法:使用主题合成分析数据。
结果:28项研究涉及来自澳大利亚的471名参与者,新西兰,包括加拿大和美国。我们确定了四个主题:家庭和文化的中心性(持续透析家庭,通过共同参与获得自主权,平衡照顾家庭的主要责任);由于结构和社会不平等而导致的边缘化(由于初级保健差距加剧了冲击,歧视和专家评判,疏远和害怕医院,被旅行淹没,财务和团体负担);获得医疗保健的脆弱性(需要符合文化要求的护理,缺乏语言口译员,没有决策机构,合并症加剧了自我管理的复杂性);并因与社区分离而感到沮丧(在透析时被剥夺了公民权和悲伤,无法延续文化连续性,寻求肾脏移植)。
结论:我们只收录了英文发表的文章。
结论:接受透析的土著患者在医疗保健方面的不平等加剧了由定植引起的现有可及性问题。与土著利益相关者合作,改善透析和肾脏移植服务的可及性和文化响应性,有望改善接受透析的土著患者的体验。
Indigenous People suffer a high burden of kidney disease. Those receiving maintenance dialysis have worse outcomes compared with similarly treated non-Indigenous patients. We characterized the experiences of Indigenous patients receiving dialysis in British-colonized countries to gain insights into which aspects of kidney care may benefit from improvement.
A systematic
review of published qualitative interview studies.
Indigenous Peoples aged 18 years and over, receiving hemodialysis or peritoneal dialysis in British-colonized countries.
Search terms for Indigenous Peoples, dialysis, and qualitative research were entered into Medline, Embase, PsycINFO, and CINAHL and searched from inception to January 5, 2023.
Characteristics of each study were extracted into Microsoft Excel for quality assessment.
Data were analyzed using thematic synthesis.
The analysis included 28 studies involving 471 participants from Australia, New Zealand, Canada, and the United States. We identified four themes: centrality of family and culture (continuing dialysis for family, gaining autonomy through shared involvement, balancing primary responsibility to care for family); marginalization due to structural and social inequities (falling through gaps in primary care intensifying shock, discriminated against and judged by specialists, alienated and fearful of hospitals, overwhelmed by travel, financial and regimental burdens); vulnerability in accessing health care (need for culturally responsive care, lack of language interpreters, without agency in decision-making, comorbidities compounding complexity of self-management); and distress from separation from community (disenfranchisement and sorrow when away for dialysis, inability to perpetuate cultural continuity, seeking a kidney transplant).
We only included articles published in English.
Indigenous patients receiving dialysis experience inequities in health care that compound existing accessibility issues caused by colonization. Improving the accessibility and cultural responsiveness of dialysis and kidney transplant services in collaboration with Indigenous stakeholders holds promise to enhance the experience of Indigenous patients receiving dialysis.
Worldwide Indigenous populations suffer a high incidence of chronic disease leading to lower life expectancy, particularly for kidney disease, an insidious condition requiring long-term dialysis treatment. By listening to Indigenous dialysis patients\' stories, we hoped to understand how to improve their experience. We gathered 28 qualitative research studies from four countries reporting Indigenous adults\' experiences of dialysis. They described lacking awareness of kidney disease, poor access to health services, systemic racism, inadequate cultural safety, and being dislocated from family, community, and culture. These findings indicate that respectful collaboration with Indigenous Peoples to craft and implement policy changes holds promise to improve prevention, integrate culturally responsive health care practices, and provide better access to local dialysis services and opportunities for kidney transplants.