Barriers and Opportunities to Increase Home Dialysis Among African American Patients
- Navigating a Path to Diversity and Equity in Kidney Health
November 03, 2023 | Location: Room 107, Pennsylvania Convention Center
Abstract Time: 05:33 PM - 05:42 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
- Odama, Unini, DaVita Inc, Denver, Colorado, United States
- Eaton, Karen-Marie, Davita Clinical Research, Minneapolis, Minnesota, United States
- Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
- Radney, Danelle, DaVita Inc, Denver, Colorado, United States
- Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
Home dialysis offers patients another treatment option for kidney failure. Home dialysis use is lower in African American patients. In this study we sought to understand the experiences that patients and care partners face and uncover influencing factors and barriers to home dialysis use.
A total of 29 participants (African American patients at a dialysis provider, both in-center and home, and their care partners) were recruited to join in-person focus groups held in December 2022 and February 2023. Focus groups were audio and video recorded and transcribed verbatim. Responses were analyzed using inductive thematic analysis.
Patients reported that physicians did not make a clear connection between poor management of underlying health conditions and kidney failure; irrespective of a patient’s access to primary care. Patients and care partners want improved/additional education, especially regarding modality selection as some information was lost or forgotten. African American patients and care partners primarily rely on healthcare professionals (HCP) for information. However, if the patient or care partner feels the HCP is less than forthcoming or insensitive when providing information, their trust is quickly eroded. Unsurprisingly, care partners are a critical part of the decision to choose and remain on home dialysis. Faith plays a significant role for many respondents in terms of disease experience (i.e., "God is in control") and emotional support. Physician guidance was cited as the most important factor in the initial modality decision for African American patients and care partners. While most patients and care partners acknowledge the benefits of home dialysis, significant barriers included the fear of being solely responsible for a complex procedure, risk of infection, and loss of social interaction and/or support from other dialysis patients and center staff.
Opportunities exist for early and direct linkage of co-morbidities with kidney disease and consideration of patient concerns in home dialysis modality education.