Perceptions of multidisciplinary renal team members towards home dialysis therapies

Background: Patients with end stage kidney disease are encouraged to pursue home dialysis therapy with the aims of improving quality of life, increasing patient autonomy and reducing cost to health care systems. In a multidisciplinary team setting, patients interact with nephrologists, nurses and allied health staff, all of whom may influence a patient9s modality choice. Our objective was to evaluate the perceptions of all renal team members towards home dialysis therapies. Methods: Cross-sectional survey of multidisciplinary renal team members across five renal programs in British Columbia, Canada. The survey contained questions regarding primary work area, modality preference, patient and system factors that may influence modality candidacy, perceived knowledge of home therapies and need for further education. Results: A total of 334 respondents (22 nephrologists, 172 hemodialysis nurses, 49 home nurses, 20 pre-dialysis nurses, and 71 allied health) were included (48% response rate). All respondents felt that home dialysis was beneficial for patients who work or study, improved patients9 quality of life, and provided cost-savings to the system. Compared to in-center hemodialysis nurses, home therapies nurses were between 5 and 9 times more likely to favor a home therapy for patients of older age, lower socioeconomic status, lower educational level, higher burden of comorbidities and those lacking social supports. Nephrologists and patients were felt to have the most impact on modality choice, while dialysis nurses were seen as having the least impact on modality choice. Most respondents felt the need for further education in home therapies. Conclusions: The majority of multidisciplinary team members, including allied health staff, acknowledged the benefits of home therapies. There were significant discrepancies amongst team members regarding patient/system-level factors that may impact home therapies candidacy. Structured, focused and repeated education sessions for all renal team members may help to address misperceptions around factors that influence modality candidacy.