Physician Knowledge and Attitudes Toward the Adoption of Peritoneal Dialysis in the Treatment of Patients With End-Stage Kidney Disease

Abstract

IntroductionHemodialysis (HD) is a significant contributor to Medicare spending. Peritoneal dialysis (PD) is a lower-cost dialysis modality with non-inferior clinical outcomes. Recent initiatives at the federal level have emphasized shifting dialysis from in-center to home modalities, namely, PD. Such policy has been slow to impact the distribution of HD and PD due to multiple barriers, including at the provider level. Previous research has characterized the role of patient knowledge gaps and preferences in the under-utilization of PD. We sought to understand physician knowledge and attitudes toward PD to elucidate provider-level barriers to PD adoption. MethodsWe conducted a 10-question survey assessing physician comfort level, perceived knowledge, and objective knowledge of HD and PD that was distributed among the internal medicine faculty at the

Knowledge and Perception on Continuous Ambulatory Peritoneal Dialysis among Physicians Working in Selected Public Hospitals in Myanmar

“…The study from US demonstrated the impact of physician knowledge and attitudes toward PD in the under-utilization of PD as a dialysis modality; the need for increased provider education around PD candidacy and the benefits of shifting dialysis care to the home. Even in developed countries, physician knowledge and attitudes toward PD had huge impact and lead to under-utilization of PD as a dialysis modality (Lalani et al, 2022). In this study, the knowledge of physicians on CAPD was very good; their attitudes were positive.…”

“…Third portion was knowledge on possible obstacles on CAPD; PD solutions, skin infection, morbid obesity, PD catheter related problems, caregiver expertise, cost, diabetes mellitus, peritonitis, electricity and sustainability. As demonstrated in figure (2), their view on likely obstacles to CAPD were as follows: PD solutions (71%); skin infection (68%); morbid obesity (53.8%); PD catheter related problems (42%).…”

“…According to the study from Turkey, implementation of comprehensive predialysis education programs for patients, informing government and hospital officials about PD advantages, and reinforcing PD principles to the nephrologists could improve the low prevalence of PD in Turkey (Dogan et al, 2023). The study from US mentioned that the impact of physician knowledge and attitudes toward PD was essential for long term success in CAPD program (Lalani et al, 2022). Staff members with less training in and enthusiasm for PD, were less likely to recommend PD, and were more likely to cite patient preference as a barrier to PD growth.…”

“…To launch CAPD program, the physicians/nephrologists should feed the advantages and feasibility of current dialysis modality (CAPD, HD) to the Ministry/Government. Even in developed countries, physician knowledge and attitudes toward PD had huge impact and lead to under-utilization of PD as a dialysis modality (Lalani et al, 2022). Implementation of comprehensive predialysis education programs for patients, informing government and hospital officials about PD advantages, and reinforcing PD principles to the nephrologists could improve the low prevalence of PD in Turkey (Dogan et al, 2023).…”

Multi-institutional audit of outcomes after peritoneal dialysis catheter placement in Japan: What are the takeaways?

“…Despite these successes in improving catheter outcomes and reducing technique failure, the utilisation of PD in Japan has remained flat over the past decade, 1,27,28 implicating the influence of other globally recognised government, physician and patient barriers that must be addressed to effectively grow PD. [29][30][31] On a final note, throughout the manuscript, Sakurada and company used mixed terminologies of catheter patency failure and survival and technique failure and survival, but they were clear in how the terms were applied. However, it has been suggested by the SONG-PD (Standardized Outcomes in Nephrology-Peritoneal Dialysis) consensus workshop to use positively framed terminology, therefore, survival instead of failure, in reporting patient outcomes to convey a more appropriate perception of PD therapy.…”