https://orcid.org/0000-0003-1376-3368
Abstract
Background
In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients.
Methods
Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords “dialysis”, “therapeutic alliance”, and “treatment adherence and compliance”, including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009–2019) and including a proportion of Black patients >25% were included for review.
Results
Only three intervention studies met these criteria, for a total aggregated sample of 130 — mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%–91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance.
Discussion/Conclusion
Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance–enhanced, and culturally tailored hemodialysis treatment–adherence interventions among Blacks.
Acknowledgments
This work was presented as a poster at the 2019 Vanderbilt University Medical Center SRTP program supported by T35DK007383. It was supported in part by NIH NIDDK 1K23DK114566-01A1 (Umeukeje), NIA-3K02AG059140-02S1 (Bruce), and NIH R01DK03935-01A1 (Cavanaugh). KN is supported in part by NIH research grants ULITR001881 and P30AG021684. The project described was supported by the National Center for Research Resources (grant UL1 RR025975-01) and is now at the National Center for Advancing Translational Sciences (grant 2 UL1 TR000445-06). The content is solely the responsibility of the authors, and does not necessarily represent the official views of the NIH.
Disclosure
Kerri L Cavanaugh reports grants from the NIH outside the submitted work. The authors report no other possible conflicts of interest in this work.