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Reasons for underreporting of uraemic pruritus in people with chronic kidney disease: A qualitative study.

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journal contribution
posted on 26.06.2019, 08:42 by G Aresi, HC Rayner, L Hassan, JO Burton, S Mitra, C Sanders, SN Van der Veer
CONTEXT: Uraemic pruritus, or itch, is common in people with chronic kidney disease (CKD) and has a negative impact on their lives and well-being. However, for reasons currently unknown, itch often remains unreported and therefore untreated. OBJECTIVES: To explore reasons for underreporting of itch in order to provide pointers for improving itch reporting and management in people with CKD. METHODS: We interviewed adult patients with CKD who self-reported experiencing itching in the last three years (n=25), nephrologists (n=10) and nurses (n=12) from three kidney services in the United Kingdom. Topic guides were informed by previous studies and a theoretical model of self-regulation. We conducted a thematic analysis of verbatim transcripts using Framework Analysis. RESULTS: We identified three main themes reflecting factors that may influence whether itch is reported: knowledge on causes and treatment of itch (lack of awareness of the relationship between itch and CKD; lack of knowledge of treatment options); attitudes towards importance of itch as a health issue (patients' attitudes; clinicians' attitudes); and prompts for itch assessment during consultations (routine practice; itch as a marker; itch severity). CONCLUSIONS: Underreporting of itch is related to patients being unaware of its causes, accepting it as something to live with, prioritising other health issues, and the length and timing of consultations. Healthcare professionals' assessment and management of itch vary widely and are not necessarily evidence-based. Better patient information, development of clinical practice guidelines, and incorporation of routine symptom assessments into care may improve itch reporting and management in people with CKD.

Funding

This work was supported by a Kidney Research UK Innovation grant (reference IN_013_20160304).

History

Citation

Journal of Pain and Symptom Management, 2019

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Infection, Immunity and Inflammation

Version

AM (Accepted Manuscript)

Published in

Journal of Pain and Symptom Management

Publisher

Elsevier for American Academy of Hospice and Palliative Medicine, National Hospice and Palliative Care Organization, U.S. Cancer Pain Relief Committee

eissn

1873-6513

Acceptance date

11/06/2019

Copyright date

2019

Available date

26/06/2019

Publisher version

https://www.sciencedirect.com/science/article/pii/S0885392419303434?via=ihub

Language

en