The value of patient and provider reported experiences in evaluating home-based assisted peritoneal dialysis

Abstract

Rationale, aims and objectives: Assisted peritoneal dialysis (PD) is a proven intervention to support patients with functional limitations in performing home-based PD. Previous research has focused on clinical outcomes, but experiences with assisted PD have not been explored from the perspective of patients and providers. Through a 12-month pilot program called PD Assist (PDA), this study elicited these perspectives to improve the program. Methods: A 12-month pilot of PDA delivered by a contracted health service provider delivered across multiple PD units in British Columbia, Canada, was evaluated. A multi-source evaluation model was used, including the semi-structured qualitative feedback in this report. Patients and their families, PD staff and caregiver stakeholders involved in the PDA pilot project, participated in the feedback process. Qualitative feedback was codified and analyzed via a thematic approach to identify values, enablers, barriers and suggestions for PDA program improvement from the perspective of patients andproviders involved in PDA.Results: All stakeholder groups advocated for continuation of PDA services. Key reported values were patient independence, enhanced psychosocial support and relief of treatment-associated burden. Consistency and communication between involved parties were reported as enablers of success, while scheduling conflicts, geographic challenges and staffing inconsistency were viewed as barriers. Areas for program improvement included the need for more personalized services. Conclusions: Semi-structured qualitative feedback provided meaningful insights into the experiences of PDA among patients and providers that were an instrumental part of a successful pilot project and identified opportunities for further program improvement.

Social Support in the Peritoneal Dialysis Experience: A Qualitative Descriptive Study

“…Home care–assisted PD programs in particular have been shown to be very beneficial to patients. 22 This being said, home care–assisted PD programs are largely focused on instrumental support and many programs are unable to implement these types of services for all patients. Although instrumental support with PD therapy is clearly very important, our study offers evidence that social support encompasses many other elements that need to be incorporated into care to create a holistically supportive environment.…”

A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

“…One publication was identified through gray literature (14,15); gray literature documents were also identified for two programs documented in published literature (16)(17)(18). Assisted PD programs were identified in 20 unique jurisdictions, with 15 follow-up evaluations of those models (Table 1) (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The final data set included 34 studies and a total of 46,597 patients (Supplemental Appendix 3).…”

“…Within the health care professional assistance model, three types of individuals providing assistance were commonly described: a registered nurse (18-31,34-41), a licensed practical nurse (14,15), and a nurse assistant/health care aide (16,32,33,(42)(43)(44) (Table 1). In general, there is a core set of procedural assistance that can be provided by all PD assistants in the characterized models (dark blue box, Figure 2) (45).…”

“…Lastly, assisted PD provided by nurse assistants or health care aides was identified in Brazil (42), the United Kingdom (England and Northern Ireland) (33,43), and one Canadian province (British Columbia [BC]) (16,17,32,44). Generally, nurse assistants or health care aides visited patients' homes once or twice daily to provide PD assistance.…”

“…All jurisdictions encouraged additional assistance from family member(s) for the PD procedure. In both the United Kingdom and BC models, nurse assistants or health care aides were employed by contract agencies or service providers for both automated PD and continuous ambulatory PD (16,17,32,33,43,44). Further, both long-term and short-term (including respite) assisted PD was documented in only the BC assisted PD model (16,17,32,44).…”