Perceptions about the dialysis modality decision process among peritoneal dialysis and in-center hemodialysis patients

Abstract

BackgroundPatients reaching end-stage renal disease must make a difficult decision regarding renal replacement therapy (RRT) options. Because the choice between dialysis modalities should include patient preferences, it is critical that patients are engaged in the dialysis modality decision. As part of the Empowering Patients on Choices for RRT (EPOCH-RRT) study, we assessed dialysis patients’ perceptions of their dialysis modality decision-making process and the impact of their chosen modality on their lives.MethodsA 39-question survey was developed in collaboration with a multi-stakeholder advisory panel to assess perceptions of patients on either peritoneal dialysis (PD) or in-center hemodialysis (HD). The survey was disseminated to participants in the large US cohorts of the Dialysis Outcomes and Practice Patterns Study (DOPPS) and the Peritoneal DOPPS (PDOPPS). Survey responses were compared between PD and in-center HD patients using descriptive statistics, adjusted logistic generalized estimating equation models, and linear mixed regression models.ResultsSix hundred fourteen PD and 1346 in-center HD participants responded. Compared with in-center HD participants, PD participants more frequently reported that they were engaged in the decision-making process, were provided enough information, understood differences between dialysis modalities, and felt satisfied with their modality choice. PD participants also reported more frequently than in-center HD participants that partners or spouses (79% vs. 70%), physician assistants (80% vs. 66%), and nursing staff (78% vs. 60%) had at least some involvement in the dialysis modality decision. Over 35% of PD and in-center HD participants did not know another dialysis patient at the time of their modality decision and over 60% did not know the disadvantages of their modality type. Participants using either dialysis modality perceived a moderate to high impact of dialysis on their lives.ConclusionsPD participants were more engaged in the modality decision process compared to in-center HD participants. For both modalities, there is room for improvement in patient education and other support for patients choosing a dialysis modality.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1096-x) contains supplementary material, which is available to authorized users.

Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized Controlled Trial

“…Content for the decision aid was based on literature review, US Renal Data System data, 1 and results from previous EPOCH-RRT studies. 18,19 A multistakeholder panel reviewed and refined the decision aid through an iterative process. Usability testing further helped refine the content, design, and structure of the decision aid.…”

Comparison of shared decision making in patients undergoing hemodialysis and peritoneal dialysis for choosing a dialysis modality

“…The results of the present study showed a statistically significant difference between PD and HD patients in terms of the mean SDM-Q-9 score; the mean SDM score in PD patients (73.52 ± 24.68 24) was higher than HD patients (39.43 ± 31.65). In a study in the United States, Zee et al (2018) found that PD patients were more consciously involved in decision-making for the selection of the dialysis type compared to HD patients [ 58 ]. Also, in another study done by Robinski et al [ 43 ], the results showed that PD patients had a higher SDM score (83.80 ± 24.42) than HD patients (61.36 ± 34.97), which is consistent with the findings of the present study.…”

Quantifying Missed Opportunities for Recruitment to Home Dialysis Therapies

“…Further support for this comes from a recent survey of incident HD patients, of whom 47% felt that their modality decision was not entirely their own choice. 13 , 14 It could be argued that the recruitment of even a small proportion of these patients to a home therapy could have a significant beneficial impact on patients and the health care system alike. A comprehensive cost-effectiveness analysis comparing home-based with facility-based dialysis found that home-based options are associated with reduced cost to the health care system, lower travel costs, reduced need for relocation from rural communities, and higher maintenance of workforce productivity.…”

“…In addition to the general orientation provided to patients and their families regarding kidney replacement therapy options, there is evidence that providing patients with specific home-based education increases the likelihood of them choosing a home therapy. 14 , 17 These focused education sessions provide an avenue to discuss common patient-perceived barriers, alleviate fears and anxieties, and facilitate the transition to the home environement. 18 Therefore, patients who are deemed suitable for a home therapy should be offered further dedicated education to fully inform their modality decision.…”