Polypharmacy and Quality of Life Among Dialysis Patients: A Qualitative Study

Rationale & Objective: Almost all patients who receive dialysis experience polypharmacy, but little is known about their experiences with medication or perceptions toward it. In this qualitative study, we aimed to gain insight into dialysis patients' ex-periences with polypharmacy, the ways they inte-grate their medication into their daily lives, and the ways it affects their quality of life.Study Design: Qualitative study using semi-structured interviews. Setting & Participants: Patients who received dialysis from 2 Dutch university hospitals.Analytical Approach: Interviews were transcribed verbatim and analyzed independently by 2 researchers through thematic content analysis.Results: Overall, 28 individuals were interviewed (29% women, mean age 63 +/- 16 years, median dialysis vintage 25.5 [interquartile range, 15-48] months, mean daily number of medications 10 +/- 3). Important themes were as follows: (1) their own definition of what constitutes "medication," (2) their perception of medication, (3) medication routines and their impact on daily (quality of) life, and (4) interactions with health care professionals and others regarding medication. Participants generally perceived medication as burdensome but less so than dialysis. Medication was accepted as an essential precondition for their health, although participants did not always notice these health benefits directly. Medication routines and other coping mechanisms helped participants reduce the perceived negative effects of medication. In fact, medication increased freedom for some par-ticipants. Participants generally had constructive relationships with their physicians when discussing their medication. Limitations: Results are context dependent and might therefore not apply directly to other contexts.Conclusions: Polypharmacy negatively affected dialysis patients' quality of life, but these effects were overshadowed by the burden of dialysis. The patients' realization that medication is important to their health and effective coping strategies miti-gated the negative impact of polypharmacy on their quality of life. Physicians and patients should work together continuously to evaluate the impact of treatments on health and other aspects of patients' daily lives.