Recruitment and training for home hemodialysis: experience and lessons from the Nocturnal Dialysis Trial.
OBJECTIVE
We assessed perceived barriers and incentives to home hemodialysis and evaluated potential correlates with the duration of home hemodialysis training.


METHODS
Surveys were sent to the principal investigator and study coordinator for each clinical center in the Frequent Hemodialysis Network Nocturnal Trial. Baseline data were obtained on medical comorbidities, cognitive and physical functioning, sessions required for home hemodialysis training, and costs of home renovations.


RESULTS
The most commonly perceived barriers included lack of patient motivation, unwillingness to change from in-center modality, and fear of self-cannulation. The most common incentives were greater scheduling flexibility and reduced travel time. The median costs for home renovations varied between $1191 and $4018. The mean number of home hemodialysis training sessions was 27.7 +/- 10.4 (11-59 days). Average training time was less for patients with experience in either self-care or both self-care and cannulation. The number of training sessions was unrelated to the score on the Modified Mini Mental Status or Trailmaking B tests or patient's education level. Training time also did not correlate with the SF-36 Physical Function subscale but did with the modified Charlson comorbidity score and older patient age.


CONCLUSIONS
Lack of patient or family motivation and fear of the dialysis process are surmountable barriers for accepting home hemodialysis as a modality for renal replacement therapy. Formal education and scores on cognitive function tests are not predictors of training time.
Pipkin
Mary
M
Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA.
Eggers
Paul W
PW
Larive
Brett
B
Rocco
Michael V
MV
Stokes
John B
JB
Suri
Rita S
RS
Lockridge
Robert S
RS
D000367:Age Factors; D000368:Aged; D002170:Canada; D002404:Catheterization / Q000523:psychology; D016009:Chi-Square Distribution; D003071:Cognition; D015897:Comorbidity; D004522:Educational Status; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006437:Hemodialysis, Home / Q000191:economics / Q000523:psychology*; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015337:Multicenter Studies as Topic; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D018579:Patient Selection; D010361:Patients / Q000523:psychology*; D010465:Perception; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States