Why patients with ESRD do not select self-care dialysis as a treatment option.
BACKGROUND
In-center hemodialysis is the most prevalent (and resource-intense) form of dialysis in North America despite many patients being capable of performing dialysis themselves. The purpose of this study is to describe reasons in-center hemodialysis patients choose not to perform self-care dialysis and identify variables associated with a negative attitude toward self-care dialysis.


METHODS
We conducted a cross-sectional survey (return rate, 83%) of prevalent in-center hemodialysis patients and combined this with demographic and comorbidity data obtained from our prospectively maintained database. We also performed multiple logistic regression to determine factors associated with the attitude, "patients should not perform dialysis without being supervised by a nurse."


RESULTS
The most prevalent knowledge barrier was lack of a satisfactory explanation of the various techniques. The most prevalent attitude barriers were that patients should not dialyze without direct supervision, fear of failure to perform self-care dialysis adequately, and fear of social isolation. The most prevalent skill barriers were needle phobia and lack of space at home. Variables significantly associated with a negative attitude toward self-care dialysis were age/fear of substandard care (interaction), needle phobia, fear of change, fear of social isolation, and unwillingness to remain awake during dialysis.


CONCLUSIONS
This study identified a variety of barriers to self-care dialysis, and these results are being used to direct changes to our program aimed at increasing the uptake of self-care hemodialysis, which we believe will benefit both patients and health care providers and may offer a solution to nursing and resource shortages.
McLaughlin
Kevin
K
Department of Medicine, Division of Nephrology, University of Calgary and Foothills Hospital, Calgary, Alberta, Canada. kevin.mclaughlin@calgaryhealthregion.ca
Manns
Braden
B
Mortis
Garth
G
Hons
Ronald
R
Taub
Ken
K
D001290:Attitude; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006437:Hemodialysis, Home / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009656:North America; D010353:Patient Education as Topic / Q000639:trends; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data / Q000639:trends; D012934:Social Isolation; D011795:Surveys and Questionnaires / Q000592:standards