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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

Authors Blumrosen C, Desta R, Cavanaugh KL, Laferriere HE, Bruce MA, Norris KC, Griffith DM, Umeukeje EM

Received 7 May 2020

Accepted for publication 10 July 2020

Published 17 August 2020 Volume 2020:14 Pages 1435—1444


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Charlotte Blumrosen,1 Russom Desta,2 Kerri L Cavanaugh,3,4 Heather E Laferriere,5 Marino A Bruce,6 Keith C Norris,7 Derek M Griffith,8 Ebele M Umeukeje3,4

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

Correspondence: Ebele M Umeukeje
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
Tel +1 615 936-3283
Fax +1615 875-5626

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: dialysis, adherence, ESKD, African Americans, systematic review, hemodialysis

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