Perceptions and Attitudes Regarding Frailty Assessment and Physical Activity Interventions among Patients Receiving Hemodialysis and Their Clinicians.

BACKGROUND

The prevalence of frailty is high among older patients receiving hemodialysis and there is a widespread agreement that frailty may be alleviated by interventions, yet frailty assessment and management are not consistently conducted among these patients. The objective of this study was to assess perceptions and attitudes regarding frailty assessment and physical activity interventions among patients receiving hemodialysis and their clinicians in a large dialysis unit.

METHODS

Focus groups or interviews were conducted with patients (n= 9) and dialysis unit staff and providers (n= 26) from the Hines Veterans Affairs dialysis unit. Recordings from the focus groups and interviews were transcribed verbatim. Deductive and inductive qualitative analyses were used to identify emergent themes.

RESULTS

Emerging themes were organized into; 1) Perspectives and current practices about frailty testing reported by clinicians; 2) perspectives and current practices about physical activity reported by patients and clinicians, and 3) practical suggestions to increase frailty testing and physical activity interventions also reported by patients and clinicians. The clinicians in our study were supportive about frailty assessments in the dialysis unit. However, they were skeptical about the implications of the assessment to inform patient care and additional burden in an already constraint dialysis unit. Patients and clinicians also noted that at the health center, physical activity was mostly supported in the context for rehabilitation from acute illnesses. They spoke about the relevance for individualized exercise routines based on patients' preferences, capabilities and situation, as well as convenience. Clinicians also spoke about the importance of multidisciplinary approach for designing frailty reduction interventions including aspects of physical, mental and social wellbeing.

CONCLUSIONS

While there is broad stakeholder acceptability and interest in frailty assessment and frailty reduction interventions, significant operational, educational, and patient-, clinician- and systemic-level barriers must be addressed before implementation is feasible in routine dialysis unit care.