Patient, physician education remains a barrier to home dialysis implementation
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In order for patients to be ready to take on home dialysis, physicians must be properly trained and know how to prepare patients, according to a presenter at the International Conference on Dialysis.
“There certainly has been lots of attention on home dialysis editorials, and taskforces have written about the increase in Advancing American Kidney Health initiative in terms of increasing home dialysis adoption. As everyone's aware, there is a lofty goal of starting patients on preemptive transplantation as well as home dialysis therapy,” Christopher T. Chan, MD, FRCPC, director of nephrology at University Health Network, said in the presentation. He added, “However, I would pause in this particular point in time to ask people to stop and think about how we actually approach the patient. Is the patient actually ready when we're talking to him or her about home dialysis?”
The best candidates for home dialysis are patients who are able and motivated, according to Chan. He said these patients should also have suitable housing and be willing to follow treatment, maintain equipment and monitor water and blood work.
To ensure that patients are ready to rise to these challenges, Chan said nephrologists have a responsibility to educate patients. He suggested creating individualized care programs or designing hospital education programs so that patients who experience unplanned starts can transition to dialysis with a solid understanding of treatment.
“We all think that there is a perfect recipe of teaching someone, but in fact there are different learning preferences that every one of us have,” Chan said.
Additionally, he referenced a study that explored transitional care units in which new patients on dialysis can receive emotional support, patient navigation resources and in-depth education on modality, nutrition and financial aspects of end-stage kidney disease.
Other barriers include potential vascular access infections. Chan investigated the success of a vascular access audit tool, and results revealed patients with a longer home hemodialysis vintage are at a higher risk for inappropriate vascular access techniques.
However, before the patients can be educated, physicians must also be trained. As Healio previously reported, Chan also conducted project ECHO to determine if a virtual mentoring program could truly educate physicians on home dialysis over a 6-month period. A total of 40 physicians enrolled at various stages of home dialysis training,
“It is interesting to see that the confidence and knowledge awareness, both at baseline and exit, as presented here improved in both [peritoneal dialysis] as well as home hemodialysis,” Chan said. He concluded, “I think home dialysis is uniquely positioned for growth, and at this point, we have an important alignment at the system level, the patient level and the provider level.”
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Chan C. Preparing the patients for home therapies: what works. Presented at: International Conference on Dialysis; Sept. 21-22, 2022; (hybrid meeting).
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