Uptake of Peritoneal Dialysis (PD) by Minoritized Patients: The Role of Modality Education.

Abstract

Background: In a cohort of patients with late-stage kidney disease who completed dialysis modality education and who self-identified as racial ethnic minorities, we studied characteristics of those choosing PD, and perception of usefulness of the education session in modality selection.

Methods: In this study of individuals with kidney failure cared for by nephrologists at Montefiore Medical Center, Bronx, NY, who were referred for modality education, we: 1-tested the association of patient characteristics with modality selection in 113 patients from 2021-2023, and 2-examined patient perception of the quality of modality education from 13 semi-structured interviews. We compared sociodemographic, clinical attributes, and patient responsiveness to attempts made by staff among those who selected and initiated PD to those who a-did not select PD, or b-initiated on HD urgently . We performed qualitative analysis of interviews to reach consensus on theoretical domain framework concepts and how they fit events in the kidney failure trajectory.

Results: Compared to individuals who required urgent HD, those who selected, and were initiated on, PD were younger (54 yrs vs 66 yrs), had fewer comorbidities, and did not require as many attempts to schedule modality education. Qualitative analysis of interviews showed that experience with staff and quality of information conveyed during education was generally positive, but the following gaps were identified: lack of support for the emotional trauma of kidney failure diagnosis, inability to address structural barriers to PD specific to the patient population, and the lack of a deliberate program to lessen anxiety about the responsibility of PD.

Conclusions: Incorporation of tailored content that addresses clinical comorbidity, structural barriers to care and emotional trauma constitute aspects of modality education that can be improved to increase PD uptake among minoritized patients.