Native Canadians relocating for renal dialysis. Psychosocial and cultural issues.

Abstract

OBJECTIVE: To examine the effects of relocation from remote Native communities for dialysis treatment and explore the receptiveness of patients, caregivers, and their communities to establishing a local satellite dialysis unit. Second, to examine the methodological issues inherent in a qualitative, cross-cultural study. DESIGN: Qualitative descriptive survey using semistructured interviews. SETTING: The Moose Factory Zone (MFZ), situated along the west coast of James Bay in northern Ontario, is one of four geographically defined areas of responsibility within Ontario through which the federal government provides health care services to Native Canadians. PARTICIPANTS: Twenty-four Native residents of MFZ selected by volunteer and nominative sampling techniques. Patients with end-stage or prefailure renal disease, informal caregivers and supporters, professional caregivers, and community spokespersons were included in the study population. MAIN OUTCOME MEASURES: Identification of issues important in planning dialysis services for Native patients in remote communities in the MFZ. RESULTS: Informal caregivers and both categories of patients supported in principle a proposed satellite dialysis unit at Moose Factory General Hospital. Their criticisms of the present system necessitating relocation to urban centres included inadequate social support, inconvenience and expense, and family separation. Professional caregivers generally supported establishing a local dialysis unit but had concerns regarding staff training and continuity of care. Community spokespersons also supported the proposed unit but only if quality of care could be ensured. CONCLUSIONS: Relocation for dialysis treatment disrupts social support patterns and creates psychosocial problems. Although the psychosocial advantages of providing dialysis treatment services close to home are readily apparent, other considerations, such as cost, equipment, and expertise, and training of health care personnel, make the provision of tertiary level care more difficult in isolated areas. Additional study is required to determine the impact of methodological issues inherent in qualitative cross-cultural studies such as this.

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