Symptom Experiences and Needs of Older Persons Living with Hemodialysis in Relation to Integrating Home Telehealth into Holistic End of Life Care: Phase I

Abstract

The integration of home telehealth into holistic end of life care with nurse oversight for older persons living with hemodialysis is still limited in Thailand. This study explains the symptom experiences and health care needs related to integrating a home telehealth model into end of life care for older persons living with hemodialysis (OPLH). The paper represents the first phase of a mixed methods exploratory sequential study with dominant quantitative components, carried out over a six-month period. Purposive sampling was used to collect data from 100 OPLH. The instruments included the VOICES (View of Informal Carers Evaluation of Service-ESRD/Thai - patients' version) questionnaire, the 9-item Thai Health Status Assessment questionnaire, and a demographic data form. The quantitative data were analysed using the statistical package SPSS version 17. Most of the participants had comorbid conditions (98%). The most common of these were hypertension (41.02%) followed by diabetes mellitus (23.25%). 25% had shortness of breath, and some had pain (31%), swelling (31%), anorexia some of the time (30%), and nausea and vomiting (15%). Moreover, participants also had symptoms of anxiety (23%), and moderate stress (10%). 8% had to be readmitted to hospital at least twice per month. Most participants had never received home care. The needs of the participants in relation to their holistic end of life care at home were reported in terms of: 1) knowledge of symptoms management at home; 2) activity and role management; 3) emotional management; and 4) spiritual support. The telehealth provision was mentioned by participants as an important part of their care, requiring VDO visiting, telephone counselling, and web-based education/ monitoring.