title: Clinician beliefs and attitudes about home haemodialysis: a multinational interview study.
abstract: OBJECTIVE
  To explore clinician beliefs and attitudes about home haemodialysis in global regions where the prevalence of home haemodialysis is low, and to identify barriers to developing home haemodialysis services and possible strategies to increase acceptance and uptake of home haemodialysis.
  
  
  METHODS
  Semistructured interviews, thematic analysis.
  
  
  METHODS
  15 dialysis centres in Italy, Portugal, France, Germany, Sweden and Argentina.
  
  
  METHODS
  28 nephrologists and 14 nurses caring for patients receiving in-centre haemodialysis.
  
  
  RESULTS
  We identified four major themes as being central to clinician beliefs about home haemodialysis in regions without established services: external structural barriers (ready access to dialysis centres, inadequate housing conditions, unstable economic environment); dialysis centre characteristics (availability of alternative treatments, competing service priorities, commercial interests); clinician responsibility and motivation (preserving safety and security, lack of awareness, knowledge and experience, potential to offer lifestyle benefits, professional interest and advancement); and cultural apprehension (an unrelenting imposition, carer burden, attachment to professional healthcare provision, limited awareness).
  
  
  CONCLUSIONS
  Despite recognising the potential benefits of home haemodialysis, clinicians practicing in Europe and South America felt apprehensive and doubted the feasibility of home haemodialysis programmes. Programmes that provide clinicians with direct experience of home haemodialysis could increase acceptance and motivation for home-based haemodialysis, as might service prioritisation and funding models that favour home haemodialysis.
authors.affiliation: The Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Suetonia
authors.initials: S
authors.lastname: Palmer
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.forename: Letizia
authors.initials: L
authors.lastname: Gargano
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Jörgen
authors.initials: J
authors.lastname: Hegbrant
authors.forename: Måns
authors.initials: M
authors.lastname: Olsson
authors.forename: Steven
authors.initials: S
authors.lastname: Fishbane
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli