Renal replacement Therapy and Barriers to choice: using a Mixed Methods approach to explore the Patient's Perspective

Area of Science:

• Nephrology
• Patient Psychology
• Health Services Research

Background:

• Alternative renal therapies offer improved quality of life and reduced costs for end-stage renal disease (ESRD) patients.
• Understanding patient perspectives is crucial for promoting the adoption of home dialysis and transplantation.

Purpose of the Study:

• To identify barriers and facilitators influencing patient choices for ESRD treatment modalities.
• To explore psychosocial and educational factors impacting modality selection among dialysis patients.

Main Methods:

• Qualitative focus groups (n=47) and quantitative surveys (n=113) were employed.
• Data collection focused on perceived barriers, facilitators, and educational needs related to renal replacement therapies.

Main Results:

• Fear was a primary barrier identified at diagnosis and during modality selection.
• Distrust, denial, and prior negative experiences also hindered alternative therapy adoption.
• Psychosocial factors significantly influence patient decisions regarding dialysis and transplantation.

Conclusions:

• Interventions targeting patient fear are essential for increasing uptake of alternative ESRD treatments.
• Enhanced, comprehensive pre-dialysis education can mitigate barriers and improve patient modality choice.
• Addressing psychological and educational needs is vital for successful implementation of home dialysis and transplantation.