Rizzolo Katherine, Gardner Colin, Camacho Claudia, Gonzalez Jauregui Rebeca, Waikar Sushrut S, Chonchol Michel, Cervantes Lilia
Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology, Boston, MA.
School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
Kidney Med. 2024 Sep 12;6(11):100902. doi: 10.1016/j.xkme.2024.100902. eCollection 2024 Nov.
RATIONALE & OBJECTIVE: Latinx individuals are more likely to start and remain receiving in-center hemodialysis, over home dialysis, than non-Latinx White individuals. The objective of our study was to understand the drivers of sustained in-center dialysis and deterrents of switching to home dialysis use for Latinx individuals receiving in-center dialysis.
This qualitative study used semistructured one-on-one interviews.
Latinx adults receiving in-center hemodialysis therapy at 2 urban dialysis clinics in Denver, Colorado between November 2021 and March 2023.
In-center hemodialysis, Latinx ethnicity.
Qualitative.
Interviews were analyzed with thematic analysis using inductive coding. Theoretical framework development used principles of grounded theory.
In total, 25 Latinx adults (10 [40%] female and 15 [60%] male) receiving in-center hemodialysis therapy participated. One theme demonstrated that Latinx individuals experienced hardship with in-center dialysis but used Latinx values to persevere: Psychosocial resilience using Latinx cultural values (faith and spiritual coping, belief in predestination and acceptance, optimism and positive attitude toward treatment, and positive relationships with health care professionals and peers). Two themes illustrate barriers to starting or switching to home dialysis: Insufficient knowledge of kidney replacement therapy (lack of awareness of kidney disease, lack of preparation for dialysis) and Barriers to patient-centered decision making in dialysis treatment (lack of peer perspective to guide dialysis decision making, fear and apprehension of home dialysis, lack of socioemotional support, perception of housing issues).
Most participants were from the same geographic area and country of origin, and some may have been uninsured because of immigration status.
As Latinx people are less likely to be treated with home dialysis modalities, this study offers important context as to what factors drove sustained in-center dialysis use for this population. Coping mechanisms that promoted resilience with in-center dialysis treatment motivated individuals to remain on in-center hemodialysis, and positive dialysis relationships in the dialysis center strengthened this experience. Switching to home dialysis is hindered by lack of knowledge as well as lack of patient-centered dialysis decision making. Understanding the drivers of sustained in-center hemodialysis use for Latinx individuals is important for future efforts at improving patient-centered education, framing conversations around modality choice, and care for this population.
与非拉丁裔白人相比，拉丁裔个体更有可能开始并持续接受中心血液透析，而非家庭透析。我们研究的目的是了解拉丁裔个体持续接受中心透析的驱动因素以及转向家庭透析的阻碍因素，这些个体目前正在接受中心透析治疗。
这项定性研究采用了半结构化一对一访谈。
2021年11月至2023年3月期间，在科罗拉多州丹佛市的两家城市透析诊所接受中心血液透析治疗的拉丁裔成年人。
中心血液透析、拉丁裔种族。
定性结果。
访谈采用归纳编码的主题分析进行分析。理论框架的构建采用扎根理论的原则。
共有25名接受中心血液透析治疗的拉丁裔成年人参与（10名[40%]女性和15名[60%]男性）。一个主题表明，拉丁裔个体在中心透析中经历了困难，但利用拉丁裔价值观坚持下来：运用拉丁裔文化价值观的心理社会适应能力（信仰和精神应对、对宿命的信仰和接受、对治疗的乐观和积极态度以及与医护人员和同伴的积极关系）。两个主题说明了开始或转向家庭透析的障碍：肾脏替代治疗知识不足（对肾病缺乏认识、对透析缺乏准备）以及透析治疗中以患者为中心的决策障碍（缺乏同伴观点来指导透析决策、对家庭透析的恐惧和担忧、缺乏社会情感支持、对住房问题的认知）。
大多数参与者来自相同的地理区域和原籍国，一些人可能由于移民身份而没有保险。
由于拉丁裔人群接受家庭透析治疗的可能性较小，本研究为驱动该人群持续使用中心透析的因素提供了重要背景。在中心透析治疗中促进适应能力的应对机制促使个体继续接受中心血液透析，透析中心积极的透析关系强化了这种体验。转向家庭透析受到知识缺乏以及缺乏以患者为中心的透析决策的阻碍。了解拉丁裔个体持续使用中心血液透析的驱动因素对于未来改善以患者为中心的教育、围绕透析方式选择进行沟通以及为该人群提供护理的努力非常重要。
