In-Center Dialysis Patients' and Staff Perspectives of Assisted Home Hemodialysis: A Three-Phase Feasibility Study.

Abstract

Background: The majority of growth in the rising dialysis population remains within in-center hemodialysis, stretching capacity. Despite national strategies promoting home hemodialysis, uptake remains low. Assisted home hemodialysis may overcome challenges by supporting patients who wish to dialyse at home but require assistance. This study aimed to evaluate the feasibility, interest, and operational implications of assisted home HD through multi-modal data collection amongst prevalent in-center HD patients and staff members.

Methods: A feasibility study incorporating patient surveys, focus groups, and care model development was conducted recruiting from three renal centers in the United Kingdom. Outcomes measured utilized structured patient questionnaires to assess patient perspectives, interest in assisted home HD, and assistance needs. Focus groups explored barriers and concerns regarding delivery. Hypothetical cost modeling was estimated.

Findings: Four hundred and sixty-five in-center hemodialysis patients from three UK centers participated, with a median age of 66 years. 34% of patients, a significantly younger (p < 0.01) group with higher disability (p < 0.05), answered "yes" when asked if they would consider a switch to assisted home HD, compared with 44% who answered "no", and 22% were unsure. Patients expressed varying degrees of assistance needs across dialysis tasks, with cannulation (65%), machine connection (51%), and set-up (38%). Patients voiced concerns about safety during home treatment and missing social aspects of in-center care, though many also expressed a desire for greater autonomy. Five key themes emerged around staffing practices in implementing assisted home HD, which included (i) boundaries of care, (ii) staff training and supervision, (iii) staff responsibility, (iv) back-up and support requirements, and (v) implementation strategies.

Conclusions: Assisted home HD demonstrates a feasible and desirable option for in-center dialysis patients. Assisted home HD presents as a potential model for overcoming barriers to home HD adoption by prevalent HD patients. Assisted home HD care models should explore varying levels of assistance at home. The findings of this study merit further exploration through implementation pilots and outcomes-based studies.