• Home dialysis;
  • Patient experience;
  • Compliance;
  • Negotiation


Background — There are many studies about the professional problem of renal patient non-compliance and a number describing the experience of living on dialysis. To date studies have not examined client attitudes toward their therapy.

Objectives — This paper reports a study seeking to describe characteristic attitudes towards their treatment regimen among a group living on home dialysis.

Methods — The study used a critical interpretive methodology, enabling a distinction between the professional viewpoint and the renal client perspective. Twenty home dialysis clients from one renal service in New Zealand were interviewed for an hour each in November 2004 and January 2005. Texts of the taped interviews were analysed to discover the client perspective towards their therapy in this group.

Results — During the initial period of adjustment to treatment many participants discovered their need for treatment by experimenting with the therapeutic prescription. They then used what they had learned about the therapy to alter their treatment regimen in order to maintain, as far as possible, their normal lifestyle. After modifying their therapeutic prescription to suit themselves, participants' motivation to continue meeting the ongoing demands of the treatment regimen was influenced by their perception of their individual life situation, including their relationships, work and personal attitudes towards life.

Discussion — Health professionals have interpreted renal client behaviour in relation to their therapy in terms of compliance, because effectiveness of treatment depends on their cooperation. From a client perspective their attitudes are better understood in terms of negotiation. Renal clients do not simply follow professional advice but, through a process of negotiation, seek to integrate therapy into their pattern of regular activities to maintain their normal lifestyle. Renal clients' motivation to meet the ongoing demands of treatment is not related solely to their health status, but is also affected by their general life situation. Understanding client attitudes towards therapy enables nurses to better support people living on dialysis.