Barriers to Home Hemodialysis Across Saskatchewan, Canada: A Cross-Sectional Survey of In-Center Dialysis Patients

Abstract

Background: Despite clinical and lifestyle advantages of home hemodialysis (HHD) compared with in-center hemodialysis (ICHD), it remains underutilized in our province. The aim of the study was to explore the patients’ perception and to identify the barriers to use of HHD in Saskatchewan, Canada. Objectives: The primary objective of the study was to evaluate and explore patient perceptions of HHD and to identify the obstacles for adoption of HHD in Saskatchewan. The secondary objective was to examine variations in the patients’ perceptions and barriers to HHD by center (main dialysis units vs satellite dialysis units). Design: This is a cross-sectional observational survey study. Setting: Two major centers (Regina and Saskatoon) and 5 associated satellite units attached to each center across the province of Saskatchewan. Patients: We approached all prevalent ICHD patients across Saskatchewan, 398 agreed to participate in the study. Measurements: Self-reported barriers to HHD were assessed using a questionnaire. Methods: A questionnaire was designed to determine the patients’ perceived barriers to HHD. Descriptive statistics was used to present the data. Chi-square and Mann-Whitney U test were used to compare the patients’ responses between main and satellite units Results: Satisfaction with current dialysis care (91%), increase in utility bills (65%), fear of catastrophic events at home (59%), medicalization of one’s home (54%), and knowledge deficits toward treatment modalities (54%) were the main barriers to HHD uptake. Compared with patients dialyzing in our main units, satellite patients chose not to pursue HHD more frequently because they had greater satisfaction with their current dialysis unit care (97% vs 87%, P < .001), felt more comfortable dialyzing under the supervision of medical staff (95% vs 86%, P < .007), could not afford additional utility costs (92% vs 45%, P < .001), were unaware of the risks and benefits of HHD (83% vs 33%, P < .001), had concerns over time commitments for training to HHD (69% vs 32%, P < .001), and had concern for family burnout (60.8% vs 40.6%, P < .001). Limitations: We used questionnaires to quantify known barriers, and this prevents inclusion of additional barriers that individual patients may consider important. Cross-sectional data can only be used as a snapshot. Only 398 patients agreed to participate, and the results cannot be generalized to 740 prevalent HD patients. We did not capture data on demographics (age, income, and literacy level), comorbidities, and dialysis vintage, which would have been helpful in interpretation of the results. Conclusions: Satisfaction with in-center care, lack of awareness and education, specifically in the satellite population, concerns with family burnout, expenses associated with utilities, and training time will need to be addressed to increase the uptake of HHD. Trial Registration: The study was not registered on a publicly accessible registry as it did not involve any health care intervention on human participants.

Missing In-Center Hemodialysis Sessions among Patients with End Stage Renal Disease in Banda Aceh, Indonesia

“…Slightly less than 10% of the study's participants thought their HD schedules were inconvenient. Home dialysis could be an option for these patients [31], but it is rarely provided in the clinical setting. Advocating home HD or PD could improve patients' adherence to dialysis, especially if they have conflicting schedules and transportation problems.…”

Barriers to Peritoneal Dialysis in Saskatchewan Canada: Results From a Province-Wide Survey

“…21 Dialysis by its very nature (scheduled days with consistent times) enables people to socialize with others in the waiting room or adjacent pods and allows an opportunity to form strong bonds with health care providers. 21 This bond is the strongest in satellite units with smaller numbers and primary nursing. However, it also enables them to get into a state of learned helplessness.…”

“…However, it also enables them to get into a state of learned helplessness. 21 The introduction of transition units has been seen as a way to reduce this crucial barrier to adoption to home HD utilization. Transition units, where patients are treated in a separate part of the dialysis unit for the first 30 to 60 days postinitiation, focus on education and are staffed by dedicated nurses with the intent of promoting and grooming self-care and home therapies.…”

“…We used the same methodology as our recently published article on patient-perceived barriers to home HD in SK. 10 All prevalent patients from 2 main “hubs” (Regina General Hospital and St Pauls’ Hospital), and 10 satellite units were approached. The patient survey used in this study was created collaboratively, as part of a provincial internal quality improvement initiative.…”

Is home hemodialysis a practical option for older people?

“…58 Socioeconomic barriers relating to inadequate housing space and increased utilities costs may be addressed with government subsidy and reimbursement schemes, and introduction of community houses catered for HHD. 4,42,43,59 Providing psychological and counseling support for caregivers may be required in some instances. 45 Respite care support services to alleviate demands of caregiver duties are being made more readily available in HD contexts, and might be quite unique for older patients on HHD.…”