Exploring healthcare professionals' perceptions on implementing home hemodialysis and self-assisted hemodialysis: a...

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.