Leong Felice Fangie, Liu PeiYun, Gan Shien Wen Sheryl, Phang Chee Chin, Lim Siew Hoon
Division of Nursing, Singapore General Hospital, Singapore, Singapore.
Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore.
Int Urol Nephrol. 2025 Sep 8. doi: 10.1007/s11255-025-04779-6.
To explore healthcare professionals' perceptions on the implementation of home hemodialysis and self-assisted hemodialysis in Singapore and to identify the perceived barriers, facilitators, and actionable strategies for increasing uptake.
This is a qualitative explorative study based on semi-structured face-to-face interviews conducted with a multidisciplinary group of 12 healthcare professionals at an acute teaching hospital in Singapore. Thematic analysis was used for data analysis.
Four major themes were generated: "Key considerations to offering HHD and SAHD", "Perceived factors influencing HHD and SAHD uptake" and "Future perspectives of HHD and SAHD" and "Evolving Roles of Healthcare Professionals". Participants described a wide spectrum of patient agency, defined as the ability and willingness to make decisions and engage in care. Suitability was linked to characteristics such as younger age, self-discipline, and stable medical conditions, assessed through psychological screening, home evaluations, and social support reviews, with attention to avoiding coercion. Key barriers included caregiver burden, safety concerns, and limited space at home, while perceived facilitators included patient empowerment and flexibility. To support adoption, participants advocated for stepwise progression through SAHD, the development of a supportive ecosystem, strengthened financial and policy support, and building workforce capacity. While uptake of peritoneal dialysis was not expected to decline, participants anticipated ongoing challenges in health system readiness and provider engagement and emphasized the expanding educational and consultative role of nurses, with minimal changes expected for nephrologists and renal coordinators.
This study provided actionable insights to support structured, multidisciplinary implementation of HHD and SAHD.
探讨医疗保健专业人员对新加坡家庭血液透析和自我辅助血液透析实施情况的看法，并确定感知到的障碍、促进因素以及提高采用率的可行策略。
这是一项定性探索性研究，基于对新加坡一家急症教学医院的12名多学科医疗保健专业人员进行的半结构化面对面访谈。采用主题分析法进行数据分析。
产生了四个主要主题：“提供家庭血液透析和自我辅助血液透析的关键考虑因素”、“影响家庭血液透析和自我辅助血液透析采用率的感知因素”、“家庭血液透析和自我辅助血液透析的未来展望”以及“医疗保健专业人员角色的演变”。参与者描述了广泛的患者自主性，定义为做出决策和参与护理的能力与意愿。适宜性与年龄较轻、自律性和病情稳定等特征相关，通过心理筛查、家庭评估和社会支持审查来评估，同时注意避免强制。主要障碍包括照顾者负担、安全担忧和家中空间有限，而感知到的促进因素包括患者赋权和灵活性。为支持采用，参与者主张通过自我辅助血液透析逐步推进、发展支持性生态系统、加强财政和政策支持以及建设劳动力能力。虽然预计腹膜透析的采用率不会下降，但参与者预计卫生系统准备情况和提供者参与方面仍将面临挑战，并强调护士的教育和咨询角色不断扩大，预计肾病学家和肾脏协调员的角色变化最小。
本研究提供了可行的见解，以支持家庭血液透析和自我辅助血液透析的结构化、多学科实施。
