In 2015, chronic kidney disease was ranked 12th of the global most common causes of death. The severity of chronic kidney disease, rated from glomerular filtration, is divided into five stages, with end-stage renal disease as the fifth stage or the worst stage. When the patients have reached the last severity degree, they will need renal replacement therapies, which can be done with three options. First, kidney transplantation is the best treatment for fifth-stage patients, but they need to choose the other two due to limited donors. The second option is hemodialysis. The last option is peritoneal dialysis, either with automated or continuous ambulatory peritoneal dialysis (CAPD).
By 2017, only 2% of final stage patients in Indonesia use CAPD, while 98% of 77,892 patients use hemodialysis. For the cost perspective, CAPD has a lower average cost, with IDR 81.7 million per patient per year compared to hemodialysis, with an average price of IDR 133.4 million per patient per year. Nevertheless, there are also several challenges for this CAPD to be implemented in Indonesia. The challenges include limited information about the therapy to professional health care and patients and a few CAPD dialysate solution providers. It is worsened by the limited CAPD apparatus and inadequate distribution system to cover the Indonesian archipelago.
However, a previous study explained that patients must engage continuously in different healthcare practices to implement treatment of chronic disease effectively. Together with the healthcare professional, patients should be sharing complementary knowledge in the healthcare process. Dahlia Darmayanti, an alumna of the Doctor of Science in Management program at SBM ITB, examined patient engagement activities with a healthcare professional in using CAPD treatment, which is considered essential to have an effective and positive outcome, together with her promotor and co-promotor, Togar M Simatupang and Priyantono Rudito.
The research used exploratory pilot study and qualitative methods to explore, describe, and understand patients’ experiences when interacting with healthcare professionals. The implementation of CAPD is divided into three primary periods: pre-CAPD therapy, training, and day-to-day dialysis. The researchers also divided it into three patient phases. The first phase is the adaptation, for patients who experienced CAPD therapy under one year. Then the next phase is the stabilization phase, for patients who experience the CAPD therapy between one to three years. The last is the acceptance phase, for patients who underwent CAPD therapy for more than three years. The purposive sampling data was collected from two adaptation phase patients, one stabilization phase patient, and one acceptance phase patient kept confidential. The additional requirement is that the respondent is above 18 years and willing to participate in the pilot study. It was done through in-depth interviews with semi-structured and open-ended questions.
The data was analyzed following the phenomenological method, aiming to explore and describe the phenomena of people’s life experiences. The interview was transcribed, coded using first cycle coding, and analyzed with the elemental methods. Then, the second cycle coding was processed with the pattern coding method. The result explained six main engagement activities: obtaining initial knowledge, developing knowledge and skills, feeling confident, following clinical advice, updating health conditions, and supporting CAPD therapy.
The most crucial engagement activities are obtaining initial knowledge and developing knowledge and skills in the cognitive dimension. These activities are implemented in the foundation phase, pre-CAPD therapy, and training phase. The other activity implemented in the pre-CAPD therapy phase is the confidence (the emotional dimension). However, this activity is obtained as the result of the initial knowledge. Meanwhile, updating health conditions (the cognitive dimension), following clinical advice (the behavioral dimension), and supporting CAPD therapy (the behavioral dimension) are implemented in day-to-day dialysis as follow-up activities of the training phase.
In conclusion, patient engagement with health care professionals plays an essential role in CAPD therapy as it improves health outcomes. The patients should interact with health care professionals as early as possible to learn about the available and the implication of renal replacement therapies options. Generally, the engagement activities are initiated with the cognitive dimension, followed by the emotional and the behavioral dimensions. The cognitive dimensions are essential engagement activities in pre-CAPD therapy and training phases. In the day-to-day phase, patients must have already gained sufficient engagement knowledge and experience to share their experiences confidently and recommend other patients to adopt CAPD therapy as their treatment.