Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review

Charlotte Blumrosen; Russom Desta; Kerri L Cavanaugh; Heather E Laferriere; Marino A Bruce; Keith C Norris; Derek M Griffith; Ebele M Umeukeje

doi:10.2147/PPA.S260684

Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review

Patient Prefer Adherence. 2020 Aug 17:14:1435-1444. doi: 10.2147/PPA.S260684. eCollection 2020.

Authors

Charlotte Blumrosen¹, Russom Desta², Kerri L Cavanaugh^{3

4}, Heather E Laferriere⁵, Marino A Bruce⁶, Keith C Norris⁷, Derek M Griffith⁸, Ebele M Umeukeje^{3

4}

Affiliations

¹ Case Western Reserve University School of Medicine, Cleveland, OH, USA.
² Meharry Medical College, Nashville, TN, USA.
³ Vanderbilt Center for Kidney Disease, Nashville, TN, USA.
⁴ Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Department of Population Health Science, John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.
⁷ Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA.
⁸ Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA.

Abstract

Background: In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients.

Methods: Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review.

Results: Only three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance.

Discussion/conclusion: Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.

Keywords: African Americans; ESKD; adherence; dialysis; hemodialysis; systematic review.

Publication types

Review

Abstract

Publication types

Grants and funding