Patient-Perceived Barriers to the Adoption of Nocturnal Home Hemodialysis

Abstract

Background and objectives: Nocturnal home hemodialysis (NHHD) has been shown to improve clinical outcomes, although adoption has been limited. Given the known benefits, an understanding of the barriers to adoption is needed.Design, setting, participants, & measurements: Patient-perceived barriers were studied through a cross-sectional survey of prevalent hemodialysis patients using validated instruments, study-specific questions, and ethnographic interviews. Conclusions: Patient-perceived barriers are primarily fears of self-cannulation, a catastrophic event, and the burden on family. These findings should form the basis of screening patients for interest in NHHD and serve to mitigate these concerns.

Recruitment and Training for Home Hemodialysis

“…We conducted a two-stage recruiting strategy: recruit patients to home hemodialysis and then recruit them to the randomized trial. The barriers and incentives to home hemodialysis that we identified are similar to those reported by others (13). It is important to note that these results represent the perceptions of recruiters to the study and not a direct survey of patients.…”

Effect of an In-Hospital Chronic Kidney Disease Education Program among Patients with Unplanned Urgent-Start Dialysis

“…After implementation of our program, 65% of acute starters chose in-center HD and 35% adopted home dialysis, suggesting that acute educational intervention may influence dialysis modality selection. The purpose of CKD education is to provide an informed transition to RRT and to help patients cope with barriers associated with starting a form of RRT (7)(8)(9). After receiving CKD education, patients are more likely to identify advantages of self-care dialysis (autonomy and lifestyle benefits) (10).…”

Patient selection and training for home hemodialysis

“…28 It is important to openly discuss and address concerns and these concerns are almost always surmountable with appropriate support.…”