Patient experiences of training and transition to home haemodialysis: A mixed-methods study

Nephrology (Carlton). 2017 Aug;22(8):631-641. doi: 10.1111/nep.12827.

Abstract

Aim: 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.

Conclusion: 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.

Keywords: home haemodialysis; mixed-method; qualitative; training.

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Aged
  • Female
  • Health Behavior*
  • Health Care Costs
  • Health Expenditures
  • Health Knowledge, Attitudes, Practice
  • Hemodialysis Units, Hospital*
  • Hemodialysis, Home* / economics
  • Humans
  • Interviews as Topic
  • Kidney Diseases / diagnosis
  • Kidney Diseases / economics
  • Kidney Diseases / psychology
  • Kidney Diseases / therapy*
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Patient Satisfaction
  • Patient Transfer* / economics
  • Patients / psychology*
  • Prospective Studies
  • Surveys and Questionnaires
  • Treatment Outcome
  • Western Australia