Undocumented Immigrants With Kidney Failure Value Peer Support Group Intervention

Emergency dialysis is defined as dialysis after a patient presents as critically ill. According to Lilia Cervantes, MD, and colleagues, most undocumented immigrants with kidney failure rely on emergency dialysis. Patients in that population experience significant depression and anxiety and are at increased risk for death.

The researchers conducted a qualitative and single-group prospective study to test the hypothesis that culturally and language-concordant peer support group interventions may be associated with reduced depression and anxiety and may provide emotional support. Results of the study were reported in JAMA Network Open.

The study population included undocumented immigrants with kidney failure receiving emergency dialysis at a center in Denver, Colorado, from December 2017 to July 2018. The 6-month intervention consisted of peer support group meetings in the hospital while participants were hospitalized for emergency dialysis. Data analysis was conducted from March to June 2022.

Recruitment, retention, implementation, and delivery for the intervention were tracked to assess feasibility of the program. Acceptability of the intervention was measured via structured-format interviews with participants. Themes and subthemes examining the value of peer support group intervention were identified from participant interviews and group meetings.

Of 27 individuals approached, 23 Latinix adults participated in the intervention. Nine of the 23 participants were female and 14 were male, and mean age was 47 years; recruitment rate was 85.2%. Of the 23 participants, 14 had less than a high school education, five had completed high school, and four had some college. Eleven were employed and 16 had an annual household income of <$14,999. Mean dialysis vintage was 44 months. At baseline, six had mild depression and four had moderate-to-severe depression. Six had mild anxiety and four had moderate-to-severe anxiety.

The total intervention consisted of 12 meetings, with a mean duration of 89 minutes. At the first meeting, the participants selected topics they wanted to discuss.

Of the 23 participants, five withdrew before the meetings began, and 19 attended a mean of six meetings. Reasons for withdrawing included moving to Mexico, transitioning to a different inpatient dialysis schedule, and transitioning to outpatient scheduled dialysis. Reasons for missing a meeting included admission to the medical intensive care unit, being on isolation status, change in the date of weekly hospital admission, and admission to another hospital.

Three themes emerged: (1) camaraderie and emotional support from peers; (2) solutions to improve care and resilience; and (3) emotional and physical aspects of receiving emergency dialysis. The first two themes related to the acceptability of the intervention and the third related to experiences receiving emergency hemodialysis.

The camaraderie theme expanded into five subthemes: (1) peer support is vital for people newly diagnosed with kidney failure; (2) patients need a safe space to build relationships and share difficulties with peers; (3) providing peer support in the hospital setting is ideal; (4) the intervention could provide solidarity to survive and incentives to reduce financial burdens by obtaining health insurance; and (5) the desire to maintain the sustainability of the peer support group.

Subthemes associated with the solutions to improve care and resilience theme were: (1) self-advocacy as a means for participants to improve their care; (2) self-motivation and optimism; (3) the opportunity to improve participant knowledge of kidney disease; (4) receiving emotional support from peers and caregivers; and (5) the role of faith and prayer in coping with the need for emergency dialysis.

The third theme expanded into four subthemes: (1) psychosocial and physical distress associated with kidney disease and kidney failure; (2) varying experiences with language-concordant care, including having to self-advocate for an interpreter; (3) dealing with emotional exhaustion from conversations regarding end-of-life care and advance directives; and (4) gratitude for clinicians and for emergency dialysis, saying that in their home countries, they would have died because emergency dialysis was not available.

There were some limitations to the study cited by the researchers, including the small sample size and the single-center design; all study participants being Latinix, making the findings ungeneralizable to other racial and ethnic groups; and not collecting data on race from the participants.

In conclusion, the authors said, “In this qualitative study, undocumented immigrants with kidney failure who relied on emergency dialysis described wanting to formalize a peer support group because they reported camaraderie and learned strategies to improve their resilience, including self-advocacy and optimism. Our results suggest that group peer support may be feasible and acceptable; it may also provide a patient-centered strategy to address the need for depression, anxiety, and social support services among patients with kidney failure, especially for marginalized, uninsured populations whose members report limited English proficiency.”

Takeaway Points

1. Researchers sought to determine whether culturally and language-concordant peer support group interventions would be of value to undocumented immigrants with kidney failure requiring emergency dialysis.
2. The intervention was shown to be feasible and had high recruitment, retention, and delivery rates.
3. Participants said the intervention built camaraderie and provided peer emotional support, describing the intervention as acceptable and valued.

Source: JAMA Network Open