Rizzolo Katherine, Jauregui Rebeca Gonzalez, Teakell Jade, Chonchol Michel, Waikar Sushrut S, Cervantes Lilia
Section of Nephrology, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts.
Evans Center for Implementation and Improvement Sciences, Boston University, Boston, Massachusetts.
Kidney360. 2025 Jan 1;6(1):86-94. doi: 10.34067/KID.0000000642. Epub 2024 Nov 12.
Individual-level advocacy to overcome structural barriers to home dialysis is key in improving home dialysis access for Latinx individuals. Acknowledging patient influences on dialysis modality choice is critical for Latinx individuals with kidney failure. Early, repeated education from a trusted source is important for Latinx individuals with kidney failure.
Latinx individuals experience two times the incidence of kidney failure compared with non-Latinx individuals and are less likely to use home dialysis therapies. In this qualitative study, interdisciplinary home dialysis clinicians were interviewed to understand the key factors and strategies used by clinicians to improve home dialysis uptake among the Latinx community.
One-to-one, semistructured interviews were conducted between November 2021 and March 2023 with 25 home dialysis interdisciplinary clinicians in Denver, Colorado, and Houston, Texas. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.
We identified three themes that focus on different levels of clinician advocacy in home dialysis uptake for the Latinx community: () individual patient-level advocacy (helping patients overcome social challenges to home dialysis, cultivating personalized relationships, educating patients with in-person versus phone language interpretation, understanding cultural differences in communication), () understanding patient influences on modality decision-making (acknowledging the importance of cultural concordance with clinician educator and patient peers, incorporating the patient lived experience, connecting with a patient's social support network, highlighting greater flexibility for employment, underscoring flexibility with culturally concordant foods), and () changes to education at the dialysis facility level (standardizing routine and repeated modality education, promoting early and patient-centered education).
Clinicians outlined efforts to improve access to home dialysis for Latinx groups on the patient and system level; in particular, individual-level and system-level advocacy was grounded in trusting relationships and personalized education. A future intervention that improves the quality and personalization of dialysis modality education incorporating Latinx cultural values may improve access to home dialysis for Latinx people with kidney disease.
个人层面的倡导以克服家庭透析的结构性障碍，是改善拉丁裔人群家庭透析可及性的关键。认识到患者对透析方式选择的影响，对患有肾衰竭的拉丁裔人群至关重要。来自可靠来源的早期、反复教育，对患有肾衰竭的拉丁裔人群很重要。
与非拉丁裔人群相比，拉丁裔人群肾衰竭的发病率高出两倍，且使用家庭透析疗法的可能性较小。在这项定性研究中，对跨学科家庭透析临床医生进行了访谈，以了解临床医生用于提高拉丁裔社区家庭透析接受率的关键因素和策略。
2021年11月至2023年3月期间，对科罗拉多州丹佛市和得克萨斯州休斯敦市的25名家庭透析跨学科临床医生进行了一对一的半结构化访谈。访谈进行了录音、转录，并采用主题分析法进行分析。
我们确定了三个主题，重点关注临床医生在拉丁裔社区家庭透析接受率方面不同层面的倡导：（1）个人患者层面的倡导（帮助患者克服家庭透析的社会挑战、培养个性化关系、使用面对面与电话语言翻译对患者进行教育、理解沟通中的文化差异），（2）理解患者对透析方式决策的影响（认识到与临床医生教育者和患者同伴文化契合的重要性、纳入患者的生活经历、与患者的社会支持网络建立联系、强调就业方面更大的灵活性、强调在符合文化的食物方面的灵活性），以及（3）透析机构层面教育的改变（规范常规和反复的透析方式教育、促进早期和以患者为中心的教育）。
临床医生概述了在患者和系统层面改善拉丁裔群体家庭透析可及性的努力；特别是，个人层面和系统层面的倡导基于信任关系和个性化教育。未来一项结合拉丁裔文化价值观改善透析方式教育质量和个性化的干预措施，可能会改善患有肾病的拉丁裔人群的家庭透析可及性。
