Patient education, tailored support can promote home dialysis in certain adults
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Key takeaways:
- Efforts to improve education and facilitate conversations on modality were key in promoting home dialysis in the patient population.
- Personalized support was also a key factor.
Patient-centered education and tailored support can promote an uptake of home dialysis among self-identified Hispanic or Latino adults receiving in-center dialysis, according to results of a qualitative study.
“Latinx individuals with kidney disease experience multiple barriers to adequate pre-dialysis kidney care, which can lead to unplanned and urgent hemodialysis initiation with a central venous catheter over home dialysis or preemptive transplant,” Katherine Rizzolo, MD, of the Boston University Chobanian and Avedisian School of Medicine, and Boston Medical Center section of nephrology, wrote with colleagues. “While these upstream issues impair initiation of dialysis with home therapies, little is known about why Latinx individuals continue to receive in-center hemodialysis after the initiation period.”
Researchers conducted semi-structured one-on-one interviews with 25 patients who self-identified as “Latinx/o/a/e or Hispanic” and who were on in-center hemodialysis between 2021 and 2023. Of the cohort — from two urban dialysis clinics in Denver — 40% were women and 60% were men.
The goal of the study was to explore factors influencing patients’ decision to continue in-center dialysis rather than switching to home dialysis.
Findings showed psychosocial resilience using cultural values such as faith and spiritual coping; belief in pre-destination and acceptance; optimism; and positive relationships with health care professionals and peers, help patients navigate challenges.
Rizzolo and colleagues identified key barriers to starting or switching to home dialysis, including insufficient knowledge of kidney replacement therapy and lack of awareness of kidney disease or preparation for dialysis. Meanwhile, barriers to patient-centered decision-making in dialysis treatment included lack of peer perspective, apprehension about home dialysis, lack of socioemotional support and perception of housing issues.
Coping mechanisms that benefit in-center dialysis and positive relationships within the center motivated patients to stay on in-center hemodialysis, data showed. Overall, researchers found efforts to improve education, facilitate conversations on modality and provide personalized support are key in promoting home dialysis among this population.
“In addition to culturally competent pre-dialysis care, efforts to incorporate Latinx cultural values into kidney care and education represent critical junctures in efforts to improve the modality education experience and interest in home dialysis for this population,” they wrote.
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Rizzolo K, et al. Kidney Med. 2024;doi.org/10.1016/j.xkme.2024.100902.
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