(1128) Medications and Daily Life: Experience of African-american Women Living with Kidney-related Diseases

Objectives:

Background: The purpose of this research is to provide key insights into the experiences African-American women (AAW) living with kidney-related chronic diseases have with using medications in the context of their everyday lives. African-American women (AAW) continue to have disproportionately poorer outcomes across numerous disease states, including chronic kidney disease (CKD) and other diseases associated with CKD. CKD affects 37 million Americans (14.0%), results in poor quality of life and mortality, and accounts for over $120 billion dollars of US Medicare spending annually. The widest gaps in outcomes lie with Black Americans (racial category that includes African-Americans) who have greater than 3 times the risk of developing CKD as White Americans and greater than 4 times the risk of progressing to ESKD.
The optimal time to intervene in the natural history of CKD is in its early stages, making treatment of the disease and risk factors, often with medications, a priority. While medications are powerful clinical interventions, the experience of taking medications holds significance and meaning for those who use them that relates to their practical and emotional dealings with them. Pharmacists play an integral role in the comprehensive medication management of their patients. To engage meaningfully with their patients about their medications and apply appropriate person-centered interventions, they need to have a knowledge of the medication experience as a subjective and human experience. The lived experience of African-American lies at the intersection of race, gender, and other relevant social factors impacting medication use. Thus, research designed to account for the social and cultural perspectives impacting the medication experience are needed.

Objectives: Study Aims are to: (1) Explore and describe the medication experiences of African-American women taking medications for chronic diseases related to CKD, and (2) Reveal the priorities patients have with medication-related decisions in the context of their everyday lives.

Methods: A qualitative design with phenomenological methodology was used. Recruitment was community-based and followed community-engagement principles. One-on-one interviews were conducted with seventeen African-American adult women taking at least one medication for CKD or a chronic disease that placed them at high risk (HTN or DM) for CKD. Thematic analysis was inductive and rooted in the traditions of phenomenology described by Max Van Manen. The existential structures of the lifeworld described by the twentieth-century French philosopher Merleau-Ponty guided the analytic approach and grounded the analysis in human embodiment and perception. Transparency of research procedures consistent with Van Manen and deep attention to researcher reflexivity were maintained to ensure rigor and trustworthiness.

Results: Five themes and associated sub-themes are described: (1) guided by a personal agency with medications, (2) sense of personal duty to care for self and others, (3) making sense of the body and self with medications, (4) staying on track with medications and with life, and (5) desire to living freely with medications and from their constraints. Thematic descriptions incorporate lived existentials of temporality, relationality, corporality, sexuality, and spatiality interpreted through the lens of Merleau-Ponty. Priorities with medication taking behaviors in daily living were revealed to be: (1) safety and security, (2) singularity of experience, and (3) autonomy and vitality.

Conclusions: Pharmacists have an important role to assist patients in the optimal management of their medications. Knowledge of the medication experience informed by phenomenology and the philosophy of MP is a useful framework with which to understand medications that is grounded in what it means to be a social and cultural being. Pharmacists may then be better equipped to engage with African-American women and base their interactions regarding medications on what is meaningful to them and consistent with their priorities in how they wish to live their lives.