Authors:
Yuvaram N V Reddy, Matthew D Kearney, Michaela Ward, Robert E Burke, Ann M O'Hare, Peter P Reese, Meghan B Lane-Fall & IM-HOME Advisory Board
University of Washington affiliated authors are displayed in bold.
✪ Open Access
Published: June 204
Read the full text in the open access journal American Journal of Kidney Disease
Abstract:
Rationale & Objective
Developing strategies to improve home dialysis use requires a comprehensive understanding of barriers. We sought to identify the most important barriers to home dialysis use from the perspective of patients, care partners, and providers.
Study Design
This is a convergent parallel mixed-methods study.
Setting and Participants
We convened a 7-member advisory board of patients, care partners, and providers who collectively developed lists of major patient/care partner-perceived barriers and provider-perceived barriers to home dialysis. We used these lists to develop a survey that was distributed to patients, care partners, and providers—through the American Association of Kidney Patients and the National Kidney Foundation. The surveys asked participants to (1) rank their top 3 major barriers (quantitative) and (2) describe barriers to home dialysis (qualitative).
Analytic Approach
We compiled a list of the top 3 patient/care partner-perceived and top 3 provider-perceived barriers (quantitative). We also conducted a directed content analysis of open-ended survey responses (qualitative).
Results
There were 522 complete responses (233 providers; 289 patients/care partners). The top 3 patient/care partner-perceived barriers were fear of performing home dialysis; lack of space; and the need for home-based support. The top 3 provider-perceived barriers were poor patient education; limited mechanisms for home-based support staff, mental health, and education; and lack of experienced staff. We identified 9 themes through qualitative analysis: limited education; financial disincentives; limited resources; high burden of care; built environment/structure of care delivery that favors in-center hemodialysis; fear and isolation; perceptions of inequities in access to home dialysis; provider perspectives about patients; and patient/provider resiliency.
Limitation
This was an online survey that is subject to nonresponse bias.
Conclusions
The top 3 barriers to home dialysis for patient/care partners and providers incompletely overlap, suggesting the need for diverse strategies that simultaneously address patient-perceived barriers at home and provider-perceived barriers in the clinic.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**