Barriers to Home Haemodialysis.
Despite clinical and cost advantages, home haemodialysis remains underused because patients and clinicians perceive different barriers — patients fear performing dialysis and lack space and home support, while providers cite poor patient education and inadequate staffing and infrastructure.
Background
Home dialysis modalities, including home haemodialysis, are used by only a minority of patients with kidney failure even though they are cost-effective and linked to improved outcomes. Significant variation exists between centres, and overcoming barriers requires understanding the perspectives of patients, care partners, and providers simultaneously rather than assuming they share the same concerns.
Key findings
In a national US mixed-methods survey of 522 respondents (233 providers and 289 patients/care partners), the top patient and care-partner barriers were fear of performing home dialysis, lack of space, and the need for home-based support. Providers instead ranked poor patient education, limited mechanisms for home-based support and mental health resources, and lack of experienced staff as the leading obstacles. Recurring qualitative themes included financial disincentives, high care burden, fear and isolation, and a care-delivery structure that favours in-centre haemodialysis.
Clinical implications
Because patient-perceived and provider-perceived barriers only partly overlap, expanding home haemodialysis use will require diverse strategies that address patient fears and home support at one end and clinic-level education, staffing, and infrastructure at the other. Single-centre experience confirms that many patients who initially choose home haemodialysis never start it because of potentially reversible barriers such as poor inter-clinic communication, training delays, and changes of mind once established on in-centre dialysis.
Category
Research
Source
Blood Purif
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