“Who matters most?”: Clinician perspectives of influence and recommendation on home dialysis uptake

Walker, Rachael; Marshall, Roger; Howard, Kirsten; Morton, Rachael L.; Marshall, Mark R.

doi:10.1111/nep.12920

Cited by 13 publications

(13 citation statements)

References 43 publications

(38 reference statements)

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“…18,19 In our study, clinicians further reiterated the need for all team members to use remote monitoring, including nephrologists and nephrologists-in-training as a team approach would help further enhance patient-focused care. A team approach is fundamental to patients commencing home dialysis treatments 20 and providing quality of care for patients on PD 21 and training and support for nephrologist and nephrologists-in-training to fully utilise remote monitoring may help to overcome this.…”

Section: Discussionmentioning

confidence: 99%

Clinicians’ experiences with remote patient monitoring in peritoneal dialysis: A semi-structured interview study

et al. 2020

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Background: Fear of catastrophic events and uncertainty about safety at home are barriers to choosing peritoneal dialysis (PD). Remote monitoring may address these concerns and is increasingly being used in patients on automated peritoneal dialysis (APD). This study aims to describe clinicians’ perspectives and experiences of remote monitoring in caring for patients on PD. Methods: We conducted semi-structured interviews with nephrologists and dialysis nurses across nine dialysis units in New Zealand who had experience using remote monitoring with patients on APD. Interviews were transcribed and analysed using thematic analysis. Results: Thirteen registered nurses and 12 nephrologists or nephrologists-in-training (total N = 25) participated. Four themes were identified: promoting and maintaining PD (providing reassurance to patients through continual surveillance, supporting confidence at home and sustaining PD as the patient-preferred treatment); enabling data-driven decisions (using comprehensive clinical data in providing timely and accessible care, and identifying and supporting patient adherence); establishing boundaries for use (negotiating privacy and independence, clarifying clinician and patient responsibilities and strengthening nursing innovation and capability); and enhancing patient-focused care (developing empathy for patients, enabling self-management and reducing time and financial burden in accessing care). Conclusions: Remote monitoring is valued by clinicians in promoting and maintaining patients on PD and enabling data-driven decisions. Remote monitoring enhances patient-focused care, but clinicians also emphasise the need to protect patient privacy and establish boundaries for use. Remote monitoring that supports the clinicians’ role and adheres to principles of data security maintains patient privacy may enhance care and outcomes for patients on PD.

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Section: Discussionmentioning

confidence: 99%

Clinicians’ experiences with remote patient monitoring in peritoneal dialysis: A semi-structured interview study

et al. 2020

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“…21 Additionally, studies of dialysis modality choice suggest that patients place a high value on nephrologists' treatment recommendations. [22][23][24] In contrast, our findings in patients with less advanced CKD suggest that patients who have not yet initiated kidney replacement therapy still rely heavily on their non-nephrologist providers for medical care and CKD treatment and advice. In this study, participants who were in nephrology care longer and who completed more nephrology visits in the previous 2 years were more likely to rely on their nephrologists for medical care.…”

Section: Discussionmentioning

confidence: 99%

Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?

et al. 2020

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“…Recent studies in the NZ population have identified a lack of confidence, fear of isolation, fear of self‐needling and financial constraints as key barriers to HHD uptake . Additionally, clinician recommendation has a significant impact on decision making around the modality choice, with several recent studies confirming that recommendation from an engaged nephrologist is a prime factor in patients choosing home haemodialysis . Our patient education programme practises a ‘Home First’ approach, emphasising a ‘lifestyle’ rather ‘medical’ match of dialysis modality.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19] Additionally, clinician recommendation has a significant impact on decision making around the modality choice, with several recent studies confirming that recommendation from an engaged nephrologist is a prime factor in patients choosing home haemodialysis. 20,21 Our patient education programme practises a 'Home First' approach, emphasising a 'lifestyle' rather 'medical' match of dialysis modality. Pre-dialysis patients attend a multidisciplinary nephrology clinic with nephrologist, nurse educator and dietitian input, and are encouraged to engage in self-care through an individually directed educational programme, using tools that guide the patient to a shared decision based on lifestyle match, irrespective of comorbidity and language barriers.…”

Section: Discussionmentioning

confidence: 99%

Changing ethnic and clinical trends and factors associated with successful home haemodialysis at Auckland District Health Board

Beig

Semple

2019

Internal Medicine Journal

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Background The health and diversity of the population in New Zealand (NZ) is changing under the influence of many socio‐economic factors. This may have shifted the landscape of home haemodialysis (HHD). Aims To examine the demographic and clinical changes, determinants of HHD training and technique outcome and mortality between 2008 and 2015 at Auckland District Health Board, NZ. Methods We compared three incident cohorts of HHD patients between 2008 and 2015. Relevant factors, including demographic and clinical characteristics, training failure, technique failure and mortality were recorded. Factors associated with training and technique failure were examined by multivariate logistic regression. Results Of 152 patients, 133 completed training, 13 (10%) experienced technique failure and 15 (11%) died. Significant changes in ethnicity (increased: Māori 1.7‐fold, Asian 1.7‐fold and Pasifika 1.4‐fold; decreased: NZ European 2.7‐fold, P = 0.001), and major comorbidities, ≥2 major comorbidities (1.8‐fold increase, P = 0.03), diabetes (2.1‐fold increase, P = 0.013) and heart failure (P = 0.04) were seen. HHD as first renal replacement therapy modality increased 15‐fold (P = 0.0001) and training time increased by 4.5 weeks (P = 0.004). Death and technique failure were unchanged over time. Shorter training time, employment and lower C‐reactive protein were associated with ‘Successful HHD’. ‘Unsuccessful HHD’ patient characteristics differed by ethnicity. Conclusions The HHD population has become more representative of the NZ population, but significantly more comorbid over time. Patient training time has increased, but mortality and technique failure remain stable. ‘Successful HHD’ is predicted by social and clinical factors, and ‘unsuccessful HHD’ may have different mechanisms in different patient groups.

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“Who matters most?”: Clinician perspectives of influence and recommendation on home dialysis uptake

Abstract: 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.

Cited by 13 publications

References 43 publications

Clinicians’ experiences with remote patient monitoring in peritoneal dialysis: A semi-structured interview study

Clinicians’ experiences with remote patient monitoring in peritoneal dialysis: A semi-structured interview study

Advanced CKD Care and Decision Making: Which Health Care Professionals Do Patients Rely on for CKD Treatment and Advice?

Changing ethnic and clinical trends and factors associated with successful home haemodialysis at Auckland District Health Board

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