Insights into the complexities of symptom management for hemodialysis patients: a systematic review of qualitative studies

Patients undergoing hemodialysis experience a broad spectrum of symptoms that impact their physical, psychological, and social well-being. Traditional qualitative studies often focus on isolated aspects of patient experiences and offer limited insights into the interconnected nature of symptom management. This systematic review and meta-ethnography aims to synthesise qualitative studies and develop a comprehensive model that elucidates interrelations between patient experiences and symptom management practices in hemodialysis. Our analysis integrated findings from 30 qualitative studies using a meta-ethnographic approach. The results revealed critical psychological and social dynamics influencing symptom management. The model highlights how supportive factors, such as family involvement and effective healthcare interactions, enhance coping mechanisms, improving emotional resilience and treatment adherence. Conversely, it identifies significant barriers, including chronic self-regulatory burnout and systemic inefficiencies, that hinder symptom management and exacerbate psychological distress. By integrating diverse qualitative findings, this study proposes a shift towards patient-centred, culturally sensitive care strategies that prioritise psychological support. This shift aims to transform hemodialysis care by addressing the complex interplay of medical, psychological, and social factors. The developed framework not only facilitates deeper understanding of the psychological impacts of symptom management and offers a structured approach for future research and interventions in this domain[Q1].