University of British Columbia, Vancouver, British Columbia, Canada.
BC Renal, Vancouver, British Columbia, Canada.
Kidney360. 2021 Aug 9;2(10):1592-1599. doi: 10.34067/KID.0006222020. eCollection 2021 Oct 28.
Patients with ESKD 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 patient's modality choice. Our objective was to evaluate the perceptions of all renal team members toward home dialysis therapies.
We performed a 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.
A total of 334 respondents (22 nephrologists, 172 hemodialysis nurses, 49 home nurses, 20 predialysis nurses, and 71 allied health staff) were included (48% response rate). All respondents felt that home dialysis was beneficial for patients who work or study, improved patients' quality of life, and provided cost savings to the system. Compared with in-center hemodialysis nurses, home therapies nurses were between five and nine 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 influence on modality choice, whereas dialysis nurses were seen as having the least effect on modality choice. Most respondents felt the need for further education in home therapies.
The majority of multidisciplinary team members, including allied health staff, acknowledged the benefits of home therapies. There were significant discrepancies among team members regarding patient-/system-level factors that may affect the candidacy of home therapies. Structured, focused, and repeated education sessions for all renal team members may help to address misperceptions around factors that influence modality candidacy.
鼓励终末期肾病患者进行家庭透析治疗，以提高生活质量、增加患者自主性并降低医疗系统成本。在多学科团队环境中，患者与肾病医生、护士和其他医疗保健人员互动，所有这些人员都可能影响患者的治疗方式选择。我们的目的是评估所有肾脏团队成员对家庭透析治疗的看法。
我们对加拿大不列颠哥伦比亚省五个肾脏项目的多学科肾脏团队成员进行了横断面调查。该调查包含关于主要工作领域、治疗方式偏好、可能影响治疗方式候选资格的患者和系统因素、对家庭治疗的认知程度以及对进一步教育的需求等问题。
共纳入 334 名受访者（22 名肾病医生、172 名血液透析护士、49 名家庭护士、20 名透析前护士和 71 名其他医疗保健人员）（48%的回应率）。所有受访者都认为家庭透析对工作或学习的患者有益，可以提高患者的生活质量并为系统节省成本。与中心血液透析护士相比，家庭治疗护士更有可能为年龄较大、社会经济地位较低、教育程度较低、合并症负担较重且缺乏社会支持的患者选择家庭治疗。肾病医生和患者被认为对治疗方式选择的影响最大，而透析护士被认为对治疗方式选择的影响最小。大多数受访者认为需要进一步接受家庭治疗方面的教育。
大多数多学科团队成员，包括其他医疗保健人员，都承认家庭治疗的益处。团队成员在可能影响家庭治疗候选资格的患者/系统层面因素方面存在显著差异。为所有肾脏团队成员提供结构化、有针对性和重复的教育课程，可能有助于解决对影响候选资格的因素的误解。
