Older peoples' satisfaction with home‐based dialysis

Derrett, Sarah; Darmody, Maryann; Williams, Sheila; Rutherford, Merrin; Schollum, John; Walker, Robert

doi:10.1111/j.1440-1797.2010.01286.x

Cited by 25 publications

(27 citation statements)

References 20 publications

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“…9 25 In contrast, previous New Zealand research has shown home-based dialysis to be highly acceptable to older adults, even when patients resided more than 1 hour from specialist services. 13 Whereas little difference in quality of life is evident between older patients on haemodialysis and peritoneal dialysis, 28 the availability of home dialysis appears to be a positive impact on quality of life, even for older patients. 14 This study seeks only to represent the perceptions, experiences and understandings of older patients living with ESKD.…”

Section: Discussionmentioning

confidence: 99%

“…Participants were interviewed in English (face-to-face), at home (only two were interviewed in a clinic setting), close to the time of treatment decision-making to precede key transitions in health status and treatment. Interviews were semistructured drawing from a predetermined set of questions (informed by a previous pilot study 13 and the wider literature) but with flexibility to pursue ideas raised by participants. 22 Interviews ceased when theoretical saturation was reached, that is, when few or no new concepts or topics were raised.…”

Section: Participant Selectionmentioning

confidence: 99%

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To dialyse or delay: a qualitative study of older New Zealanders’ perceptions and experiences of decision-making, with stage 5 chronic kidney disease

et al. 2017

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BackgroundIssues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing.Study populationParticipants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand. All participants had reached chronic kidney disease (CKD) stage 5 and had undergone dialysis education but had not started dialysis or recently started dialysis within the past 6 months.MethodologySerial qualitative interviews were undertaken to explore the decision-making processes and subsequent treatment experiences of patients with ESKD.Analytical approach: A framework method guided the iterative process of analysis. Decision-making codes were generated within NVivo software and then compared with the body of the interviews.ResultsInterviews were undertaken with 17 participants. We observed that decision-making was often a fluid process, rather than occurring at a single point in time, and was heavily influenced by perceptions of oneself as becoming old, social circumstances, life events and health status.LimitationsThis study focuses on participants' experiences of decision-making about treatment and does not include perspectives of their nephrologists or other members of the nephrology team.ConclusionsOlder patients often delay dialysis as an act of self-efficacy. They often do not commit to a dialysis decision following predialysis education. Delaying decision-making and initiating dialysis were common. This was not seen by participants as a final decision about therapy. Predialysis care and education should be different for older patients, who will delay decision-making until the time of facing obvious uraemic symptoms, threatening blood tests or paternalistic guidance from their nephrologist.Trial registration numberAustralasian Clinical Trials Registry ACTRN 12611000024943; results.

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Section: Discussionmentioning

confidence: 99%

Section: Participant Selectionmentioning

confidence: 99%

To dialyse or delay: a qualitative study of older New Zealanders’ perceptions and experiences of decision-making, with stage 5 chronic kidney disease

et al. 2017

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“…To elicit clinician beliefs and experiences, we developed a semi-structured interview guide based on a literature review on home haemodialysis (any haemodialysis at home including thrice weekly dialysis or frequent haemodialysis performed during the day or night) [15][16][17][18][19][20][21][22][23][24] and discussions between the research team (box 1). The interviews focused on knowledge of home haemodialysis, perceived benefits and risks, potential facilitators and barriers to home haemodialysis, training and support needs of clinicians, and clinical attitudes towards home haemodialysis.…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2012

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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.

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“…Follow-up questionnaires are then administered to survivors 12 and 24-months later. The questionnaires have been piloted with 60 older patients with CKD and found to be acceptable and to cover questions and issues of greatest relevance to them [8]. Each interview will be designed to take 45-60 minutes and will be conducted either on the telephone or face to face depending on patient preference.…”

Section: Methodsmentioning

confidence: 99%

Dialysis outcomes in those aged ≥65 years

et al. 2013

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BackgroundThe number of elderly people over the age of 65 commencing dialysis in NZ has increased by almost 400% in the past decade. Few data are available about health related outcomes and survival on dialysis in the elderly to help the individual, their family, clinicians and health planners with decision-making.Methods/designThis study will provide the first comprehensive longitudinal survey of health-related quality of life (HRQOL) and other patient centred outcomes for individuals aged ≥65 years on, or eligible for, dialysis therapy and will link these data to survival outcomes. Data collected by yearly structured interviews with participants will be linked to co-morbidity data, health service use, and laboratory information collected from health records, and analysed with respect to HRQOL and survival. The information obtained will inform the delivery of dialysis services in New Zealand and facilitate improved decision-making by individuals, their family and clinicians, about the appropriateness and impact of dialysis therapy on subsequent health and survival.DiscussionResults from this study will make possible more informed decision-making by future elderly patients and their families as they contemplate renal replacement therapy. Results will also allow health professionals to more accurately describe the impact of dialysis therapy on quality of life and outcomes for patients.Trial registrationACTRN12611000024943.

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Older peoples' satisfaction with home‐based dialysis

Cited by 25 publications

References 20 publications

To dialyse or delay: a qualitative study of older New Zealanders’ perceptions and experiences of decision-making, with stage 5 chronic kidney disease

To dialyse or delay: a qualitative study of older New Zealanders’ perceptions and experiences of decision-making, with stage 5 chronic kidney disease

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

Dialysis outcomes in those aged ≥65 years

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