Patient and caregiver perspectives on burnout in peritoneal dialysis

Oveyssi, Justin; Manera, Karine; Baumgart, Amanda; Cho, Yeoungjee; Forfang, Derek; Saxena, Anjali; Craig, Jonathan C.; Fung, Samuel Ka-Shun; Harris, David C.H.; Johnson, David W.; Kerr, Peter G.; Lee, Achilles; Ruiz, Lorena; Tong, Macy; Wang, Angela Yee-Moon; Yip, Terence; Tong, Allison; Shen, Jenny I.

doi:10.1177/0896860820970064

Cited by 23 publications

(16 citation statements)

References 40 publications

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“…VA is well positioned to rigorously examine best practices, outcomes, and cost effectiveness of telemedicine for home dialysis because of its robust education, training, and research infrastructure and the lack of regulatory and reimbursement-related constraints (17). Other recommendations we identified corroborate prior research including: improve awareness of home dialysis (15,16,47), peer-to-peer coaching (17), increase frequency of home visits (51), decrease patient burden (reduce treatment time, improve comfort) (15), improve functionality of equipment (15,47), enhance support for caregivers (15,16,52), improve education (15 –17,47,51), and provide health data feedback ( e.g ., immediate real-time, dialysis-related laboratory treatment data and staff notes) (53). Consistent with common practices in implementation research (54,55), supporting home dialysis will likely require drawing on several recommendations in combination to address challenges and capitalize on facilitating factors at the patient, provider, and health care system levels.…”

Section: Discussionsupporting

confidence: 69%

Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

et al. 2021

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BackgroundHome dialysis confers similar survival and greater quality of life than in-center hemodialysis for adults with ESKD but remains underutilized. We examined challenges and facilitators to implementation of home dialysis and identified stakeholder-centered strategies for improving it.MethodsWe conducted a qualitative, cross-sectional, multisite evaluation that included five geographically dispersed Veterans Health Administration (VHA) home dialysis programs. Participants included patients with ESKD receiving home dialysis, their informal caregivers, and home dialysis staff. Semistructured telephone interviews were conducted and audio-recorded from 2017 through 2018, to assess perceived barriers and facilitators to patient home dialysis use in VHA. Transcribed interviews were analyzed thematically by each participant group.ResultsParticipants included 22 patients receiving home dialysis (18 on peritoneal dialysis [PD] and four hemodialysis [HD]); 20 informal caregivers, and 19 home dialysis program staff. Ten themes emerged as challenges to implementing home dialysis, of which six (60%) spanned all groups: need for sterility, burden of home dialysis tasks, lack of suitable home environment, physical side effects of home dialysis, negative psychosocial effects of home dialysis, and loss of freedom. Four themes (40%), identified only by staff, were insufficient self-efficacy, diminished peer socialization, geographic barriers, and challenging health status. Twelve themes emerged as facilitators to implementing home dialysis, of which seven (58%) spanned all groups: convenience, freedom, avoidance of in-center HD, preservation of autonomy, adequate support, favorable disposition, and perceptions of improved health. Two themes (17%) common among patients and staff were adequate training and resources, and physical and cognitive skills for home dialysis. Recommendations to promote implementation of home dialysis common to all participant groups entailed incorporating mental health care services, offering peer-to-peer coaching, increasing home visits, providing health data feedback, and reducing patient burden.ConclusionsStakeholder-centered challenges were rigorously identified. Facilitators and recommendations can inform efforts to support home dialysis implementation.

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Section: Discussionsupporting

confidence: 69%

Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

et al. 2021

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“…The regular dialysis sessions and responsibilities associated with PD can be overwhelming and can extend naturally to family, friends and caregivers of patients 198 , 199 . Thus, minimizing patient and caregiver fatigue to improve QOL, increase patients’ adoption of PD and decrease HD transfer is important 200 .…”

Section: Other Outcomesmentioning

confidence: 99%

Epidemiology of peritoneal dialysis outcomes

et al. 2022

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Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring.

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“…In order for PD use to continue to grow among older and more medically complex patients, different strategies to promote home dialysis should be considered, such as increasing support or reimbursement of care partners who help patients to perform PD. 34…”

Section: Discussionmentioning

confidence: 99%

Increased Access, Persistent Disparities

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Kou

et al. 2023

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Peritoneal dialysis (PD) use has increased in the United States (US) since 2009, but how this has impacted disparities in PD use is unclear. We used data from the US Renal Data System (USRDS) to identify a cohort of incident dialysis patients from 2009-2019. We used logistic regression models to examine how odds of PD use changed by demographic characteristics. The incident PD population increased by 203% from 2009 to 2019, and the odds of PD use increased in every subgroup. PD use increased more among older people, as the odds for those aged ≥75 years increased 15% more per five-year period compared with individuals aged 18-44 years. (OR 1.68, 95% confidence interval [CI] 1.64-1.73 versus 1.46, 95 % CI 1.42-1.50). The odds of PD use increased 5% more per five-year period among Hispanic people compared with White people (OR 1.58, 95% CI 1.53-1.63 versus 1.51, 95% CI 1.48-1.53). There was no difference in odds of PD initiation among people who were Black, Asian or of another race. The odds of PD use increased 5% more for people living in urban areas compared with people living in non-urban areas (5-year OR 1.54, 95% CI 1.52-1.56 versus 1.46, 95% CI 1.42-1.50). The odds of PD use increased 7% more for people living in socioeconomically advantaged areas compared with people living in more deprived areas. (5-year OR 1.60, 95% CI 1.56-1.63 for neighborhoods with lowest Social Deprivation Index versus OR 1.50, 1.48-1.53 in the most deprived areas). Expansion of PD use led to a reduction in disparities for older people and for Hispanic people. Although PD use increased across all strata of socioeconomic deprivation, the gap in PD use between people living in the least deprived areas and those living in the most deprived areas widened.

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Patient and caregiver perspectives on burnout in peritoneal dialysis

Cited by 23 publications

References 40 publications

Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions

Epidemiology of peritoneal dialysis outcomes

Increased Access, Persistent Disparities

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