NATIVE-CANADIANS RELOCATING FOR RENAL DIALYSIS - PSYCHOSOCIAL AND CULTURAL ISSUES

OBJECTIVE To examine the effects of relocation from remote Native comm unities for dialysis treatment and explore the receptiveness of patien ts, caregivers, and their communities to establishing a local satellit e dialysis unit. Second, to examine the methodological issues inherent in a qualitative, cross-cultural study. DESIGN Qualitative descriptiv e survey using semistructured interviews. SETTING The Moose Factory Zo ne (MFZ), situated along the west coast of James Bay in northern Ontar io, is one of four geographically defined areas of responsibility with in Ontario through which the federal government provides health care s ervices to Native Canadians. PARTICIPANTS Twenty-four Native residents of MFZ selected by volunteer and nominative sampling techniques. Pati ents with end-stage or prefailure renal disease, informal caregivers a nd supporters, professional caregivers, and community spokespersons we re included in the study population. MAIN OUTCOME MEASURES Identificat ion of issues important in planning dialysis services for Native patie nts in remote communities in the MFZ. RESULTS Informal caregivers and both categories of patients supported in principle a proposed satellit e 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 sepa ration. Professional caregivers generally supported establishing a loc al dialysis unit but had concerns regarding staff training and continu ity of care. Community spokespersons also supported the proposed unit but only if quality of care could be ensured. CONCLUSIONS Relocation f or dialysis treatment disrupts social support patterns and creates psy chosocial 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 o f health care personnel, make the provision of tertiary level care mor e difficult in isolated areas. Additional study is required to determi ne the impact of methodological issues inherent in qualitative cross-c ultural studies such as this.