title: Patient experiences of training and transition to home haemodialysis: A mixed-methods study.
abstract: OBJECTIVE
  This study aims to describe patients' perspectives on the transition to home haemodialysis.
  
  
  METHODS
  Up to three sequential semi-structured interviews were conducted with 20 patients during the transition to home haemodialysis at an Australian renal unit. Transcripts were analysed thematically. Participants completed a satisfaction questionnaire after commencing home haemodialysis.
  
  
  RESULTS
  We identified six themes: persevering despite trepidations (diminishing intimidation of machinery, acquiescing to fatal risks, reconciling fears of cannulation, dispelling concerns of neglect and tolerating necessary concessions); optimizing the learning pathway (practising problem solving, learning from mistakes, grasping technical complexity, minimizing cognitive overload and progressing at own pace); developing confidence (believing in own abilities, adapting to independence, depending on caregiver partnership and faith in crisis support); interrupted transition momentum (lacking individual attention, language barriers, installation delays, interfering illness and complications and acclimatizing to new conditions); noticing immediate gains (reclaiming lifestyle normality, satisfying self-sufficiency, personalizing treatment regime and thriving in a positive environment); and depleting resources and energy (exhaustion with gruelling routine, confronting medicalization of the home, draining financial reserves and imposing family burden). Fewer than 30% of respondents indicated low satisfaction with staff availability domains, staff interpersonal domains or technical domains.
  
  
  CONCLUSIONS
  Home haemodialysis training fosters confidence in patients; however, many patients experience stress because of medical isolation, treatment responsibilities, family impositions and financial difficulties. Addressing patient's on-going psychosocial concerns may alleviate burdens on patients and their families during the transition to home haemodialysis.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.affiliation: Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Centre for Transplant and Renal Research, The Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Harris
authors.affiliation: Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.|School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Lukas K
authors.initials: LK
authors.lastname: Kairaitis
authors.affiliation: Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Maryann
authors.initials: M
authors.lastname: Nicdao
authors.affiliation: Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Mikaheal
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.|Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006436:Hemodialysis Units, Hospital; D006437:Hemodialysis, Home / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D007674:Kidney Diseases / Q000175:diagnosis / Q000191:economics / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010360:Patient Transfer / Q000191:economics; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014904:Western Australia
keywords: home haemodialysis; mixed-method; qualitative; training