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Morita PP, Huynh K, Zakir A, Cafazzo JA, McQuillan RF, Bargman JM, Chan CT. Supporting the Establishment of New Home Dialysis Programs Through the Explore Home Dialysis Program. Kidney Int Rep 2019; 4:293-300. [PMID: 30775626 PMCID: PMC6365366 DOI: 10.1016/j.ekir.2018.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The globally increasing prevalence of chronic kidney disease has resulted in an ever-growing demand for renal replacement therapy. Although programs are present around the world, there is a paucity of immersive educational programs that train clinicians and administrators to develop new home dialysis programs. Explore Home Dialysis (EHD) is a program created to fill this gap. METHODS We present the results of the evaluation of the EHD program. Our team interviewed 23 clinicians and administrators who participated in the EHD program. We also assessed country-specific needs and challenges associated with home dialysis. RESULTS The 4 main findings include (i) the evaluation of the effectiveness of the EHD program; (ii) the need for an educational program to train individuals on how to deploy home dialysis programs; (iii) evidence that such an educational program is beneficial to participants and for the establishment of new home dialysis programs; and (iv) the identification of barriers to the development of home dialysis programs in countries represented in this study. The data show an increased demand, with strong patient and provider interest in establishing new programs, interest in accessing resources to train clinical and administrative staff in how to run a home dialysis program, and positive feedback about the EHD program in general. CONCLUSIONS The data from this study were used in the next iteration of the EHD program, to inform clinicians about challenges in the deployment of new home dialysis programs, and to present educational resources that need to be developed in the future.
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Affiliation(s)
- Plinio P. Morita
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Huynh
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Areeba Zakir
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Joseph A. Cafazzo
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Rory F. McQuillan
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joanne M. Bargman
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher T.M. Chan
- Division of Nephrology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Division of Nephrology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Combes G, Sein K, Allen K. How does pre-dialysis education need to change? Findings from a qualitative study with staff and patients. BMC Nephrol 2017; 18:334. [PMID: 29169332 PMCID: PMC5701386 DOI: 10.1186/s12882-017-0751-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-dialysis education (PDE) is provided to thousands of patients every year, helping them decide which renal replacement therapy (RRT) to choose. However, its effectiveness is largely unknown, with relatively little previous research into patients' views about PDE, and no research into staff views. This study reports findings relevant to PDE from a larger mixed methods study, providing insights into what staff and patients think needs to improve. METHODS Semi-structured interviews in four hospitals with 96 clinical and managerial staff and 93 dialysis patients, exploring experiences of and views about PDE, and analysed using thematic framework analysis. RESULTS Most patients found PDE helpful and staff valued its role in supporting patient decision-making. However, patients wanted to see teaching methods and materials improve and biases eliminated. Staff were less aware than patients of how informal staff-patient conversations can influence patients' treatment decision-making. Many staff felt ill equipped to talk about all treatment options in a balanced and unbiased way. Patient decision-making was found to be complex and patients' abilities to make treatment decisions were adversely affected in the pre-dialysis period by emotional distress. CONCLUSIONS Suggested improvements to teaching methods and educational materials are in line with previous studies and current clinical guidelines. All staff, irrespective of their role, need to be trained about all treatment options so that informal conversations with patients are not biased. The study argues for a more individualised approach to PDE which is more like counselling than education and would demand a higher level of skill and training for specialist PDE staff. The study concludes that even if these improvements are made to PDE, not all patients will benefit, because some find decision-making in the pre-dialysis period too complex or are unable to engage with education due to illness or emotional distress. It is therefore recommended that pre-dialysis treatment decisions are temporary, and that PDE is replaced with on-going RRT education which provides opportunities for personalised education and on-going review of patients' treatment choices. Emotional support to help overcome the distress of the transition to end-stage renal disease will also be essential to ensure all patients can benefit from RRT education.
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Affiliation(s)
- Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Kim Sein
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, B15 2TT, UK
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