The Perspectives of Adults Living With Peritoneal Dialysis: Thematic Synthesis of Qualitative Studies

Lesmana, Brian; Tong, Allison; Johnson, Doug; Wong, Germaine; Campbell, Denise; Craig, J. C.

doi:10.1053/j.ajkd.2012.08.045

Cited by 100 publications

(134 citation statements)

References 54 publications

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“…Several findings are supported by previous studies, including patient preference for home-based therapies when a longer survival and improved wellbeing were expected and preference of treatment schedules being more flexible, important for those in paid employment (8,9,25,32). Despite increasing flexibility in home dialysis scheduling, global rates of home-based dialysis remain perhaps lower than expected.…”

Section: Discussionsupporting

confidence: 63%

“…Extended, rather than shorter, training times were also preferred in a previous study (25). It has been established that patients contemplating and performing home dialysis have concerns around safety, isolation, and support (8,9,12,23) and that addressing perceived need for increased support and longer training may help to allay these concerns and support home dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…The attributes and levels used to describe each dialysis alternative were on the basis of our prior research, including qualitative interviews with patients (13,23) and thematic syntheses of patient and caregiver values, beliefs, and experiences when considering home dialysis (8,9). Levels for patient survival were obtained from the Australia New Zealand Dialysis and Transplant Registry (24) to include a range of plausible values.…”

Section: Attributesmentioning

confidence: 99%

“…Home dialysis may offer a number of advantages, including longer life expectancy (4,5), quality of life (6), flexibility (7), and the ability to maintain employment (8)(9)(10). However, patients and families may choose facility-based dialysis to avoid out of pocket costs (power, water, and heating) or because of a perception of less clinical support, social isolation, or a fear of having to self-manage catastrophic events (9,(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Discrete Choice Study of Patient Preferences for Dialysis Modalities

Walker

Morton

Palmer

et al. 2017

CJASN

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Background and objectives Improved knowledge about factors that influence patient choices when considering dialysis modality could facilitate health care interventions to increase rates of home dialysis. We aimed to quantify the attributes of dialysis care and the tradeoffs that patients consider when making decisions about dialysis modalities.Design, setting, participants, & measurements We conducted a prospective, discrete choice experiment survey with random parameter logit analysis to quantify preferences and tradeoffs for attributes of dialysis treatment in 143 adult patients with CKD expected to require RRT within 12 months (predialysis). The attributes included schedule flexibility, patient out of pocket costs, subsidized transport services, level of nursing support, life expectancy, dialysis training time, wellbeing on dialysis, and dialysis schedule (frequency and duration). We reported outcomes using b-coefficients with corresponding odds ratios and 95% confidence intervals for choosing home-based dialysis (peritoneal dialysis or hemodialysis) compared with facility hemodialysis.Results Home-based therapies were significantly preferred with the following attributes: longer survival (odds ratio per year, 1.63; 95% confidence interval, 1.25 to 2.12), increased treatment flexibility (odds ratio, 9.22; 95% confidence interval, 2.71 to 31.3), improved wellbeing (odds ratio, 210; 95% confidence interval, 15 to 2489), and more nursing support (odds ratio, 87.3; 95% confidence interval, 3.8 to 2014).

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Attributesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Discrete Choice Study of Patient Preferences for Dialysis Modalities

Walker

Morton

Palmer

et al. 2017

CJASN

Self Cite

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“…Previous syntheses of qualitative research have explored the perspectives of patients with CKD on particular issues (including end of life care [10], vascular access [11], and dietary restrictions [12]) or specific patient groups, such as patients on peritoneal dialysis (13). Although most patients requiring dialysis treatment receive in-center hemodialysis, no previous qualitative synthesis has focused on their experiences.…”

Section: Introductionmentioning

confidence: 99%

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Reid

Seymour

Jones

2016

CJASN

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Background and objectives Patients on in-center dialysis spend significant amounts of time in the dialysis unit; additionally, managing ESRD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis, their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesize the experiences of patients receiving in-center hemodialysis.Design, setting, participants, & measurements We searched Embase, MEDLINE, CINAHL, PsychINFO, Google Scholar, and reference lists for primary qualitative studies published from 1995 to 2015 that explored the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted.Results Seventeen studies involving 576 patients were included in the synthesis. Four analytic themes were developed. The first theme (a new dialysis-dependent self) describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme (a restricted life) describes the physical and emotional constraints that patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future, and these contributed to the third theme (regaining control). The first three themes describe a potential for change through acceptance, adaption, and regaining a sense of control. The final theme (relationships with health professionals) describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity, and personalized support.Conclusions Our synthesis has resulted in a framework that can be used to consider interventions to improve patients' experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships that patients have with their health care professionals may enable patients to progress toward a sense of control and improve satisfaction with care.

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Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022

Johansen

Liu

et al. 2023

JAMA Netw Open

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ImportanceThe Centers for Medicare &amp; Medicaid Services designed a mandatory payment model to incentivize home dialysis use: the End-Stage Renal Disease Treatment Choices (ETC). Outpatient dialysis facilities and health care professionals providing nephrology services were randomly assigned to ETC participation at the hospital referral region level.ObjectiveTo assess the association between ETC and home dialysis use in the incident dialysis population in its first 18 months of implementation.Design, Setting, and ParticipantsA cohort study with controlled, interrupted time series analysis of the US End-Stage Renal Disease Quality Reporting System database was conducted, using generalized estimating equations. All adults initiating home-based dialysis in the US between January 1, 2016, and June 30, 2022, without a prior kidney transplant were included in the analysis.ExposuresPrior to vs after ETC onset in January 1, 2021, and random assignment to ETC participation of facilities and health care professionals involved in patient care.Main Outcomes and MeasuresPercentage of patients started on incident home dialysis and yearly change in percentage initiating home dialysis.ResultsA total of 817 177 adults initiated home dialysis during the study period, of whom 750 314 were included in the study cohort. The cohort included 41.4% women; 26.2% of the patients were Black, 17.4% were Hispanic, and 49.1% were White. Approximately half (49.6%) of the patients were aged at least 65 years. A total of 31.2% received care from health care professionals assigned to ETC participation, and 33.6% had Medicare fee-for-service coverage. Overall, home dialysis use increased from 10.0% in January 2016 to 17.4% in June 2022. Home dialysis use increased more in ETC markets than in non-ETC markets after January 2021 (by 1.07%; 95% CI, 0.16%-1.97%). The rate of increase in home dialysis use in the entire cohort nearly doubled after January 2021 to 1.66% per year (95% CI, 1.14%-2.19%) compared with before 2021, when the rate was 0.86% per year (95% CI, 0.75%-0.97%), but the difference in rate of increase in home dialysis use was not significant between ETC and non-ETC markets.Conclusions and RelevanceThis study noted that, although the overall rate of dialysis use at home was greater after ETC implementation, the increase occurred more among patients in ETC markets than among those in non-ETC markets. These findings suggest that federal policy and financial incentives affected care for the entire incident dialysis population in the US.

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The Perspectives of Adults Living With Peritoneal Dialysis: Thematic Synthesis of Qualitative Studies

Cited by 100 publications

References 54 publications

A Discrete Choice Study of Patient Preferences for Dialysis Modalities

A Discrete Choice Study of Patient Preferences for Dialysis Modalities

A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis

Association of the End-Stage Renal Disease Treatment Choices Payment Model With Home Dialysis Use at Kidney Failure Onset From 2016 to 2022

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