Abstract: TH-PO557

Perspectives of Healthcare Professionals on Access to Emergency-Only Hemodialysis for Undocumented Immigrants with ESKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention

Authors

  • Cervantes, Lilia, Denver Health, Denver, Colorado, United States
  • Richardson, Sara, Denver Health Hospital, Denver, Colorado, United States
  • Raghavan, Rajeev, Baylor College of Medicine, Houston, Texas, United States
  • Hou, Nova, University of Texas at Houston Medical School, Houston, Texas, United States
  • Tong, Allison, The University of Sydney, Sydney, New South Wales, Australia
  • Hasnain, Romana, Denver Health, Denver, Colorado, United States
  • Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
Background

Providing emergency-only hemodialysis for undocumented immigrants with end-stage kidney disease (ESKD) is challenging for healthcare providers as access is variable across the United States, can be legally and ethically complex, and is highly distressing for patients. We aimed to describe the perspectives of healthcare professionals on providing healthcare (emergency-only hemodialysis) to undocumented immigrants with ESKD.

Methods

We conducted face-to-face, semi-structured interviews with 50 healthcare professionals (nurses [N=16], physicians [N=27], physician assistants [N=3], social workers [1], and dieticians [1], certified nurse assistants [2]) at Denver Health (Denver, CO) and Harris Health (Houston, Texas). Interviews were transcribed and analyzed using thematic analysis.

Results

We identified five themes: Frustrated with hospital operations and care delivery (impersonal rationing of healthcare, struggle to provide primary care in the inpatient setting, inefficiencies lead to unnecessary labs and imaging, and lower priority for undocumented patients); overwhelmed by intense patient and family burden (advocating for a palliative care focus, anger seeing patients suffer when their friends die and receive cardiopulmonary resuscitation, disheartened when patients appear depressed and tired from the weekly accumulation of symptoms leading up to admission, and empathy for their families who struggle when patients require higher level of care); distressed by severity of patient condition (conflicted when patients take desperate measures to meet critically ill criteria, higher acuity care is commonplace, and frustrated by limited care options); and sense of uncertainty from the complex political and financial influence (lacking clarity about cost-benefit, sense that immigration status should not limit access to hemodialysis because other states provide routine dialysis, and desire to change current model of care because this care is more expensive and cruel).

Conclusion

Healthcare professionals are burdened by their patient’s suffering and advocate for routine hemodialysis care.

Funding

  • Private Foundation Support