Clinician beliefs and attitudes about home haemodialysis: a multinational interview study

Abstract

ObjectivesTo explore clinician beliefs and attitudes about home haemodialysis in global regions where the prevalence of home haemodialysis is low, and to identify barriers to developing home haemodialysis services and possible strategies to increase acceptance and uptake of home haemodialysis.DesignSemistructured interviews, thematic analysis.Setting15 dialysis centres in Italy, Portugal, France, Germany, Sweden and Argentina.Participants28 nephrologists and 14 nurses caring for patients receiving in-centre haemodialysis.ResultsWe identified four major themes as being central to clinician beliefs about home haemodialysis in regions without established services: external structural barriers (ready access to dialysis centres, inadequate housing conditions, unstable economic environment); dialysis centre characteristics (availability of alternative treatments, competing service priorities, commercial interests); clinician responsibility and motivation (preserving safety and security, lack of awareness, knowledge and experience, potential to offer lifestyle benefits, professional interest and advancement); and cultural apprehension (an unrelenting imposition, carer burden, attachment to professional healthcare provision, limited awareness).ConclusionsDespite recognising the potential benefits of home haemodialysis, clinicians practicing in Europe and South America felt apprehensive and doubted the feasibility of home haemodialysis programmes. Programmes that provide clinicians with direct experience of home haemodialysis could increase acceptance and motivation for home-based haemodialysis, as might service prioritisation and funding models that favour home haemodialysis.

Prospective monitoring of after‐hours nursing and technologist support calls to a regional Canadian home hemodialysis program

“…First, this report adds to the literature of patient safety and patient reassurance in the conduct of home HD. Despite previous reports demonstrating a low‐serious adverse rate in home HD, patients and providers often cite fears of catastrophic events as a barrier for the uptake of home dialysis . The provision of after‐hours on‐call support can considerably allay such worries and provide reassurance that a serious adverse event may be prevented.…”

“…Despite previous reports demonstrating a lowserious adverse rate in home HD, 10 patients and providers often cite fears of catastrophic events as a barrier for the uptake of home dialysis. 15,16 The provision of after-hours on-call support can considerably allay such worries and provide reassurance that a serious adverse event may be prevented. It is reassuring that among the 239 issues raised with the on-call nurses only five were deemed to be of a more serious nature, and we speculate that one of the reasons why home HD has such a lowserious adverse event rate is that patients are taught to solicit help when they have questions or there are abnormalities in the course of their treatment, and in turn, experienced on-call nursing staff appropriately manage or triage patient-raised issues before patients deteriorate.…”

An Incident Cohort Study Comparing Survival on Home Hemodialysis and Peritoneal Dialysis (Australia and New Zealand Dialysis and Transplantation Registry)

“…Although PD and HHD both require a certain degree of autonomy and commitment, the relative complexity of HHD demands higher levels of empowerment, which might have accounted for the relatively small proportion of patients on HHD in this study and the problems encountered with patient recruitment in previous HHD trials (53). Nephrologists are also known to have a major influence over a patient's choice of modality, and their own opinions toward PD and HHD can contribute to differences in PD and HHD cohorts (3,(54)(55)(56). Thus, the survival advantage associated with HHD in this incident cohort could be related to unmeasured differences in patients treated with PD and HHD rather than the treatment itself.…”

Is replacement modality choice knowledge important in the non-renal multidisciplinary team? Experience from a single UK centre

“…In 2012, Tong et al 26 conducted a semi-structured interview among nephrologists and in-centre dialysis nurses to explore their beliefs and attitudes about HHD, and identify barriers to HHD and strategies to increase its uptake. The study concluded that programmes that provide clinicians with direct experience of HHD could increase acceptance and motivation for home-based haemodialysis.…”

“…The study concluded that programmes that provide clinicians with direct experience of HHD could increase acceptance and motivation for home-based haemodialysis. 26 We think that wider awareness about home dialysis therapy among the non-renal MDT -who see a significant number of CKD patients -might increase the uptake of home dialysis, especially in those patients that might be under another medical team for a good number of years who have therefore gained their confidence and trust. Hence, nephrologists' efforts should be focused on educating themselves and their colleagues about home therapies.…”