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Abstract: FR-PO663

Barriers and Facilitators to Home Dialysis in Older Veterans: Perspectives from Patients and Caregivers

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Fischer, Michael J., Jesse Brown VAMC, Chicago, Illinois, United States
  • Jones, Lindsey A., Department of Veterans Affairs, Hines, Illinois, United States
  • Fiandaca, Cindi, Edward Hines Jr. VA Hospital, Hines, Illinois, United States
  • Hogan, Timothy Patrick, Veterans Health Administration, Bedford, Massachusetts, United States
  • Smith, Bridget M., Hines VA Hospital, Hines, Illinois, United States
  • Gordon, Elisa J., Northwestern University, Chicago, Illinois, United States
Background

Home-based dialysis - hemodialysis (HD) or peritoneal dialysis (PD) – often confers greater survival and quality of life, and lower morbidity than in-center hemodialysis for patients with end-stage renal disease (ESRD). However, home dialysis is underutilized, especially among older adults. To understand this underutilization, we assessed barriers and facilitators to home dialysis from the perspectives of older Veterans and their caregivers.

Methods

Semi-structured telephone interviews were conducted and audio-recorded separately with Veterans receiving home dialysis through VA and their informal caregivers in five VA facility-based programs during 2017-2018. Transcribed interviews were analyzed using content analysis to identify themes emerging from the data.

Results

Out of 82 Veterans on home dialysis (78 PD, 4 HD), 63 (77%) had informal caregivers. We interviewed 20 Veterans (24% participation rate) and their 20 caregivers (32% participation rate). Most Veterans were male (100%), white (77%), with an average age of 64 years. Most caregivers were female (95%), white (78%), with an average age of 63 years. Most Veterans (54%) believed that they needed their caregiver to assist in performing home dialysis. Key patient-level barriers included unsuitable home environment, lack of self-efficacy in administering home dialysis treatments, and physical disability. Important facilitators included having sufficient space at home, knowledge/training on performing home dialysis, and caregiver support. Significant caregiver-level barriers included unsuitable home environment, lack of self-efficacy in administering home dialysis treatments, and competing job duties. Common facilitators included personal devotion to the Veteran, knowledge/training of the home dialysis procedure, and VA dialysis staff support. Veterans and caregivers similarly supported interventions to foster home dialysis, including telemedicine applications and paid stipends for caregivers.

Conclusion

Informal caregivers play a key role in supporting home dialysis for older adults. Interventions should address both patient and caregiver barriers to increase use of home dialysis.

Funding

  • Veterans Affairs Support