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Allison Tong - One of the best experts on this subject based on the ideXlab platform.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Allison Tong, Kirsten Howard, Mark R. MarshallAbstract:Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs.Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically.In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival.To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically. RESULTS In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival. CONCLUSIONS To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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Patient and caregiver values, beliefs and experiences when considering Home Dialysis as a treatment option: a semi-structured interview study.
Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2015Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis
Rachael C Walker - One of the best experts on this subject based on the ideXlab platform.
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“Who matters most?”: Clinician perspectives of influence and recommendation on Home Dialysis uptake
Nephrology (Carlton Vic.), 2017Co-Authors: Rachael C Walker, Rachael L Morton, Kirsten Howard, Roger Marshall, Mark R. MarshallAbstract:Aim There is little research exploring the association between clinicians' behaviours and Home Dialysis uptake. This paper aims to better understand the influence of clinicians on Home Dialysis modality recommendations and uptake. Methods Online survey of all NZ renal units to determine the influence of individuals within pre-Dialysis teams. We used the self-declaration scale of influence to rate the identified member's perceived influence on decision-making. We used this measure of ‘decisional power’ to compare the perceived influence of pre-Dialysis nurses with nephrologists using both parametric and non-parametric methods. We developed a generalized linear model to investigate the relationship between the influence of nephrologists and pre-Dialysis nurses with Home Dialysis uptake by individual centre using additional data from Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Finally, respondents rated the importance of a list of patient and service-level factors in recommendations for Home Dialysis. Results Data suggest the nephrologists are the most influential member of the pre-Dialysis team. This contrasts with perceptions of survey respondents who view pre-Dialysis nurses as most influential. Nephrologists' recommendations are likely to be a successful way of increasing Home Dialysis. A single point increase in nephrologist decisional power is associated with a 6.1% increase in the prevalence of Home Dialysis. Conclusion The decisional power around Home Dialysis in NZ sits with nephrologists. It is therefore critical that nephrologists exercise their decisional power in advocating Home Dialysis and address reasons why they may not recommend Home Dialysis to well-suited and appropriate patients.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Allison Tong, Kirsten Howard, Mark R. MarshallAbstract:Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs.Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically.In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival.To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically. RESULTS In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival. CONCLUSIONS To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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Patient and caregiver values, beliefs and experiences when considering Home Dialysis as a treatment option: a semi-structured interview study.
Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2015Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis
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Systems to cultivate suitable patients for Home Dialysis.
Hemodialysis International, 2015Co-Authors: Rachael C Walker, Christopher R. Blagg, David C. MendelssohnAbstract:The key to developing, initiating, and maintaining a strong Home Dialysis program is a fundamental commitment by the entire team to identify and cultivate patients who are suitable candidates to perform Home Dialysis. This process must start as early as possible in the disease trajectory, and must include a passionate and daily focus by physicians, nurses, social workers, and other members of the multidisciplinary team. This effort must be constant and sustained over months, with active promotion of Home Dialysis for suitable patients at every opportunity. Cultivation of suitable patients must become a defining and overarching mission for the entire program. This article reviews some of the components involved in this worthwhile effort and provides practical tips and links to resources.
Mark R. Marshall - One of the best experts on this subject based on the ideXlab platform.
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“Who matters most?”: Clinician perspectives of influence and recommendation on Home Dialysis uptake
Nephrology (Carlton Vic.), 2017Co-Authors: Rachael C Walker, Rachael L Morton, Kirsten Howard, Roger Marshall, Mark R. MarshallAbstract:Aim There is little research exploring the association between clinicians' behaviours and Home Dialysis uptake. This paper aims to better understand the influence of clinicians on Home Dialysis modality recommendations and uptake. Methods Online survey of all NZ renal units to determine the influence of individuals within pre-Dialysis teams. We used the self-declaration scale of influence to rate the identified member's perceived influence on decision-making. We used this measure of ‘decisional power’ to compare the perceived influence of pre-Dialysis nurses with nephrologists using both parametric and non-parametric methods. We developed a generalized linear model to investigate the relationship between the influence of nephrologists and pre-Dialysis nurses with Home Dialysis uptake by individual centre using additional data from Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Finally, respondents rated the importance of a list of patient and service-level factors in recommendations for Home Dialysis. Results Data suggest the nephrologists are the most influential member of the pre-Dialysis team. This contrasts with perceptions of survey respondents who view pre-Dialysis nurses as most influential. Nephrologists' recommendations are likely to be a successful way of increasing Home Dialysis. A single point increase in nephrologist decisional power is associated with a 6.1% increase in the prevalence of Home Dialysis. Conclusion The decisional power around Home Dialysis in NZ sits with nephrologists. It is therefore critical that nephrologists exercise their decisional power in advocating Home Dialysis and address reasons why they may not recommend Home Dialysis to well-suited and appropriate patients.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Allison Tong, Kirsten Howard, Mark R. MarshallAbstract:Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs.Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically.In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival.To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically. RESULTS In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival. CONCLUSIONS To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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Patient and caregiver values, beliefs and experiences when considering Home Dialysis as a treatment option: a semi-structured interview study.
Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2015Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis
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Survival on Home Dialysis in New Zealand.
PloS one, 2014Co-Authors: Mark R. Marshall, Rachael C Walker, Kevan R. Polkinghorne, Kelvin L. LynnAbstract:Background New Zealand (NZ) has a high prevalence of both peritoneal Dialysis (PD) and Home haemoDialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if Home Dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities. Methods We analysed survival by time-varying Dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression. Results We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on Home HD are younger and healthier. Compared to facility HD, Home Dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period ( 3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era. Conclusion Our study supports the culture of Home Dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.
Christopher T. Chan - One of the best experts on this subject based on the ideXlab platform.
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Overcoming Barriers for Uptake and Continued Use of Home Dialysis: An NKF-KDOQI Conference Report.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2020Co-Authors: Christopher T. Chan, Eric Wallace, Kelli Collins, Erich P. Ditschman, Lisa Koester-wiedemann, Tonya L. Saffer, Michael V. RoccoAbstract:Home Dialysis modalities are used in a minority of patients with kidney failure in the United States. During the 2018 National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) Home Dialysis Conference, numerous ideas were suggested to help minimize barriers for the uptake and retention of Home Dialysis therapies. First, educational tools are needed to increase knowledge about Home Dialysis modalities (eg, continuous ambulatory peritoneal Dialysis, continuous cycling peritoneal Dialysis, and Home hemoDialysis). Implementation of a hub and spoke model, pairing smaller and/or newer Home Dialysis programs with larger more sophisticated programs that offer education and mentoring, may help Dialysis programs to grow and prosper. This pairing can be facilitated by traditional conferences and newer modalities such as telemedicine and training applications. Peer support to patients, such as that offered through the NKF Peers Program, and support and respite to care partners can have beneficial effects toward both increasing the number of patients who choose Home Dialysis as a modality and improving retention in Home Dialysis programs. Anticipating and understanding both patient and care partner burden is important for the development and implementation of patient- and care partner–centered support programs that can be deployed before a patient ceases Home therapy. Finally, aligning Medicare reimbursement to support appropriate increased Home Dialysis uptake to prioritize both transplantation and Home Dialysis as the first-line treatments for kidney failure.
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are adverse events in newly trained Home Dialysis patients related to learning styles a single centre retrospective study from toronto canada
BMJ Open, 2020Co-Authors: Joanne M. Bargman, Bourne L. Auguste, Michael Girsberger, Claire Kennedy, Thatsaphan Srithongkul, Margaret Mcgrathchong, Christopher T. ChanAbstract:Objectives Home haemoDialysis (HD) and peritoneal Dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, Home Dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients’ learning styles are associated with differing risk of adverse events in both Home HD and PD patients. Design Retrospective cohort study. Setting Tertiary care hospital in Toronto, Ontario, Canada. Participants One hundred and eighteen prevalent adult (≥18 years) Home Dialysis patients (40 PD and 78 Home HD) were enrolled. Patients on Home Dialysis for less than 6 months or receiving Home nursing assistance for Dialysis were excluded from the study. Interventions Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. Primary and secondary outcome measures Home HD and PD adverse events were identified within 6 months of completing Home Dialysis training. Event rates were then stratified and compared according to learning styles. Results Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, Dialysis modality, training duration, Dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of Home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). Conclusions Different learning styles in Home Dialysis patients exist. Visual learning styles are associated with fewer adverse events in Home Dialysis patients within the first 6 months of completing training. Individualisation of Home Dialysis training by learning style is warranted.
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Predictors of Care Gaps in Home Dialysis: The Home Dialysis Virtual Ward Study
American journal of nephrology, 2019Co-Authors: Annie-claire Nadeau-fredette, Joanne M. Bargman, Christopher T. Chan, Michael Copland, S Neil Finkle, Matthew J. Oliver, Robert P. Pauly, Jeffrey Perl, Nikhil Shah, Deborah ZimmermanAbstract:Background: Home Dialysis patients may be at an increased risk of adverse events after transitional states. The Home Dialysis virtual ward (HDVW) trial was conducted in Canadian Dialysis centers and aimed to evaluate potential care gaps and patient satisfaction during the HDVW. Methods: The HDVW was a multicenter single-arm trial including peritoneal Dialysis and Home hemoDialysis patients after 4 different events (hospital discharge, medical procedure, antibiotics, completion of training). Telephone-led interviews using a standardized assessment tool were performed over a 2-week period to assess a patient’s care and adjust treatment as required. Upon completion, patients were surveyed to evaluate their perceived impact on domains of care using a rating scale; 1 not satisfied to 10 completely satisfied. Results: The HDVW trial included 193 patients with a median number of potential care gaps/interventions of 1 (0–2) per patient. Patients admitted to the HDVW after hospital discharge were at a higher risk of potential gaps in care (OR 2.16, 95% CI 1.29–3.62), while longer Dialysis vintage was associated with a lower number of gaps/interventions (OR 0.97 per year, 95% CI 0.95–0.98). A total of 105/193 (54%) patients completed satisfaction surveys. Patients were highly satisfied with the HDVW (median rating scale score 8, IQR 2) and felt it had a positive impact (rating scale score ≥7) on their overall health, understanding of treatment and access to a nephrologist. Conclusion: The HDVW was effective at identifying several potential care gaps, and patients were satisfied across several domains of care. This intervention may be valuable in supporting Home Dialysis patients during care transitions.
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Home Dialysis Among Elderly Patients: Outcomes and Future Directions:
Canadian journal of kidney health and disease, 2019Co-Authors: Bourne L. Auguste, Christopher T. ChanAbstract:Elderly patients who receive Home Dialysis (peritoneal Dialysis or Home hemoDialysis) may have reduced survival compared to younger patients. Therefore, it is important to ascertain the goals of Home Dialysis in the elderly rather than simply fixate on standard metrics such as technique survival. As Canada's population continues to age, the prevalence of end-stage kidney disease among the elderly population is increasing. Patients with multiple comorbidities are now surviving long enough to be started on Dialysis. Although Home Dialysis has been associated with better survival and improved quality of life, its impact on the frail and elderly populations require further elucidation. Home Dialysis patients can either independently perform tasks or have support in the Home to safely conduct Dialysis. Moreover, patients burdened with frailty and multiple comorbidities who lack support in the Home may not be able to perform Home Dialysis safely. Innovative strategies to improve accessibility to Home-based therapies need further exploration. In addition, the concept of goal-directed Dialysis promotes more individualized treatment. Future continuous quality improvement initiatives must examine if goal-directed Dialysis leads to better quality of life outcomes in the elderly.
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Exploring Barriers and Potential Solutions in Home Dialysis: An NKF-KDOQI Conference Outcomes Report.
American journal of kidney diseases : the official journal of the National Kidney Foundation, 2018Co-Authors: Christopher T. Chan, Eric Wallace, Mitchell H. Rosner, Thomas A. Golper, Rebecca Kurnik Seshasai, Joel D. Glickman, Martin J. Schreiber, Patrick Gee, Michael V. RoccoAbstract:Home Dialysis therapy, including Home hemoDialysis and peritoneal Dialysis, is underused as a modality for the treatment of chronic kidney failure. The National Kidney Foundation–Kidney Disease Outcomes Quality Initiative sponsored a Home Dialysis conference in late 2017 that was designed to identify the barriers to starting and maintaining patients on Home Dialysis therapy. Clinical, operational, policy, and societal barriers were identified that need to be overcome to ensure that Dialysis patients have the freedom to choose their treatment modality. Education of patients and patient partners, as well as health care providers, about Home Dialysis therapy, if offered at all, is often provided in a cursory manner. Lack of exposure to Home Dialysis therapies perpetuates a lack of familiarity and thus a hesitancy to refer patients to Home Dialysis therapies. Patient and care partner support, both psychosocial and financial, is also critical to minimize the risk for burnout leading to dropout from a Home Dialysis modality. Thus, the facilitation of Home Dialysis therapy will require a systematic change in chronic kidney disease education and the approach to Dialysis therapy initiation, the creation of additional incentives for performing Home Dialysis, and breakthroughs to simplify the performance of Home Dialysis modalities. The Home Dialysis work group plans to develop strategies to overcome these barriers to Home Dialysis therapy, which will be presented at a follow-up Home Dialysis conference.
Kirsten Howard - One of the best experts on this subject based on the ideXlab platform.
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“Who matters most?”: Clinician perspectives of influence and recommendation on Home Dialysis uptake
Nephrology (Carlton Vic.), 2017Co-Authors: Rachael C Walker, Rachael L Morton, Kirsten Howard, Roger Marshall, Mark R. MarshallAbstract:Aim There is little research exploring the association between clinicians' behaviours and Home Dialysis uptake. This paper aims to better understand the influence of clinicians on Home Dialysis modality recommendations and uptake. Methods Online survey of all NZ renal units to determine the influence of individuals within pre-Dialysis teams. We used the self-declaration scale of influence to rate the identified member's perceived influence on decision-making. We used this measure of ‘decisional power’ to compare the perceived influence of pre-Dialysis nurses with nephrologists using both parametric and non-parametric methods. We developed a generalized linear model to investigate the relationship between the influence of nephrologists and pre-Dialysis nurses with Home Dialysis uptake by individual centre using additional data from Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Finally, respondents rated the importance of a list of patient and service-level factors in recommendations for Home Dialysis. Results Data suggest the nephrologists are the most influential member of the pre-Dialysis team. This contrasts with perceptions of survey respondents who view pre-Dialysis nurses as most influential. Nephrologists' recommendations are likely to be a successful way of increasing Home Dialysis. A single point increase in nephrologist decisional power is associated with a 6.1% increase in the prevalence of Home Dialysis. Conclusion The decisional power around Home Dialysis in NZ sits with nephrologists. It is therefore critical that nephrologists exercise their decisional power in advocating Home Dialysis and address reasons why they may not recommend Home Dialysis to well-suited and appropriate patients.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Allison Tong, Kirsten Howard, Mark R. MarshallAbstract:Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs.Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically.In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival.To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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patient and caregiver values beliefs and experiences when considering Home Dialysis as a treatment option a semi structured interview study
Nephrology Dialysis Transplantation, 2016Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis <1 year) and their caregivers, recruited from three nephrology centres in New Zealand. Transcripts were analysed thematically. RESULTS In total, 43 patients [pre-Dialysis (n = 18), peritoneal Dialysis (n = 13), Home haemoDialysis (n = 4) and facility haemoDialysis (n = 9)] and 9 caregivers participated. We identified five themes related to Home Dialysis: lacking decisional power (complexity of information, limited exposure to Home Dialysis, feeling disempowered, deprived of choice, pressure to choose), sustaining relationships (maintaining cultural involvement, family influence, trusting clinicians, minimizing social isolation), reducing lifestyle disruption (sustaining employment, avoiding relocation, considering additional expenses, seeking flexible schedules, creating free time), gaining confidence in choice (guarantee of safety, depending on professional certainty, reassurance from peers, overcoming fears) and maximizing survival. CONCLUSIONS To engage and empower patients and caregivers to consider Home Dialysis, a stronger emphasis on the development of patient-focused educational programmes and resources is suggested. Pre-Dialysis and Home Dialysis programmes that address health literacy and focus on cultural and social values may reduce fears and build confidence around decisions to undertake Home Dialysis. Financial burdens may be minimized through provision of reimbursement programmes, employment support and additional assistance for patients, particularly those residing in remote areas.
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Patient and caregiver values, beliefs and experiences when considering Home Dialysis as a treatment option: a semi-structured interview study.
Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2015Co-Authors: Rachael C Walker, Suetonia C Palmer, Rachael L Morton, Kirsten Howard, Mark R. Marshall, Allison TongAbstract:BACKGROUND Home Dialysis can offer improved quality of life and economic benefits compared with facility Dialysis. Yet the uptake of Home Dialysis remains low around the world, which may be partly due to patients' lack of knowledge and barriers to shared and informed decision-making. We aimed to describe patient and caregiver values, beliefs and experiences when considering Home Dialysis, to inform strategies to align policy and practice with patients' needs. METHODS Semi-structured interviews with adult patients with chronic kidney disease Stage 4-5D (on Dialysis