Health care management strategies of long-term dialysis survivors.

This qualitative, exploratory-descriptive study describes self-management strategies of long-term survivors of dialysis. Data were collected via long, semi-structured interviews with 18 individuals, 10 male and 8 female, who had been on dialysis for more than 15 years. Of these, 10 participants were Caucasian, 4 were African-American, and 4 were Hispanic. Respondents ranged in age from 38 to 63 years. Interviews were audio-recorded, and verbatim transcriptions of interviews were analyzed according to a content analytic procedure, with movement from specific to general. Six broad patient self-management strategies were identified: impression management, selective symptom report/management, vigilant oversight of care, self-proposal of treatments, active self-advocacy, and independent adoption of treatments/use of alternative therapies. For the individuals interviewed, self-management was largely constituted as management of the health care system and health care providers who represent it. Although the small sample size and the exploratory-descriptive methodology limit generalizability, valuable insights into techniques for self-management were derived. Such insights pave the way for future research into characteristics that distinguish dialysis patients who have the potential to be effective self-managers. More importantly, understanding of successful self-management by individuals on dialysis lays the groundwork for development of interventions to help other patients develop similar positive self-management strategies.