Why are hemodialysis treatments shortened and skipped? Development of a taxonomy and relationship to patient subgroups.

Shortening and skipping hemodialysis treatments occur commonly and are associated with inadequate dialysis and increased mortality. These behaviors are also frequently equated with patient noncompliance. The prevalence and demographic correlates of shortening and skipping treatments have been studied extensively. However, less is known about the reasons for shortening and skipping treatments and whether patient characteristics correlate with specific reasons. Understanding the relationship between reasons and patient characteristics is essential for determining whether patient subgroups are at a disadvantage in achieving optimal dialysis and may help guide future interventions. Semistructured interviews were conducted with 168 selected patients who shortened or skipped treatments. A variety of reasons were responsible for shortening and skipping hemodialysis treatments. Content analysis of patient responses revealed five categories of reasons for shortening and skipping, including medical problems, technical problems, life tasks, transportation, and patient decisions. The most common reasons for shortening were medical problems (38%) and life tasks (24%), while the most common reasons for skipping were life tasks (33%) and transportation (22%). Furthermore, patient subgroups differed in the reasons for shortening and skipping. After multivariate adjustment for patient characteristics, technical problems were more common among women. Life tasks were more common among men, younger patients, and patients with hypertension. Transportation problems were more common among African Americans. Interventions to optimize hemodialysis treatment should identify and target patient-specific reasons for shortening and skipping and not assume noncompliance. [ABSTRACT FROM AUTHOR]