The Effects of Nurse-Led Coaching on Discordant Home Hemodialysis Patients.

Introduction: Home hemodialysis (home HD) has demonstrated superior clinical outcomes, improved quality of life, and enhanced treatment flexibility in comparison to 3 days/week in-center HDs. Nonetheless, some patients are discordant with their dialysis prescription and require a coaching program in order to maintain their normal lifestyle and ameliorate their illness behavior.

Objective: To describe the feasibility of conducting a nurse-led coaching program for discordant home HD patients and its effect on hospitalization and technique complications.

Methods: This is a retrospective single center observational cohort study of all prevalent home HD patients at University Health Network (UHN) from the period of January 2018 to December 2022. Demographic and clinical data were extracted from chart review. Nurses conducted weekly motivational interviewing with patients by phone, email, or in-clinic visits in the home HD unit to discuss the importance of being concordant to treatment and adapting the length and schedule of dialysis to avoid clinical complications. Health coaching was defined as patient-centered, incorporating patient-determined goals, self-discovery processes, accountability, and content information in the context of an ongoing helping relationship. Patients were categorized as concordant, concordant with agreement doing at least 75% of dialysis prescription, or discordant for those skipping/shortening home HD sessions without prior agreement with the clinical team. Comparisons were carried out using chi-squared or ANOVA testing as appropriate. p < 0.05 was defined as statistical significance.

Results: From 94 patients, 61 were concordant and 33 (35%) required coaching: 15 (16%) were concordant patients with agreement and 18 (19%) were discordant patients. Patients' demographics were summarized respectively for concordant patients, concordant with agreement, and for discordant patients. Age was 51 (37-61), 53 (47-61), 46 (35-54) [p = 0.102]; male gender was 62%, 53%, 72% [p = 0.519]; diabetes status was 21%, 7%, 6% [p = 0.219] and proportions of patients living alone were 13%, 7%, 17% [p = 0.739]. Patients requiring coaching tended to have a higher median time on home HD, 7.6 versus 4.3 years [p = 0.145] and tended to be less likely to be listed for kidney transplant [p = 0.174]. There were no differences in hospitalization and technique complications among patients who required coaching versus standard care.

Conclusion: We demonstrated that it is feasible to provide coaching to home HD patients. Ongoing clinical testing of nurse-led coaching in home HD is warranted.