Abstract: FR-PO1075
Identification of Goals and Priorities of Patients Receiving Home Dialysis
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Saad, Simon, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada
- O'Connor, Patrick Réjean, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada
- Robitaille, Émilie, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada
- Elftouh, Naoual, Hopital Maisonneuve-Rosemont Centre de Recherche, Montreal, Quebec, Canada
- Imbeault, Benoit, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada
- Nadeau-Fredette, Annie-Claire, Universite de Montreal Faculte de Medecine, Montreal, Quebec, Canada
Background
Patient-centered care is essential in home dialysis, but identifying patients' priorities and individualizing care remains challenging. This study aimed to identify patients' goals of care (and clinician awareness) and evaluate their associations with clinical outcomes, taking into account baseline frailty.
Methods
Patients on peritoneal dialysis (PD) and home hemodialysis (HHD) graded eight predetermined goals of care on a 0-10 Likert scale and selected their two most important goals. Nephrologists and nurses independently guessed patients' two main goals. Responses were compared using concordance analysis and McNemar's test. Frailty was assessed using the Clinical Frailty Scale (CFS). Composite outcomes (hospitalization, transfer to HD and mortality) were evaluated in a Cox proportional hazards model.
Results
78 prevalent patients were recruited (65 ±13 yrs; 29% female; 69% PD/31% HHD). "Live as long as possible" was the most selected goal (Figure 1A). Partial concordance (agreement on 1 of 2 goals) occurred in 55% of patient-nephrologist and 54% of patient-nurse pairs; complete concordance in 13% and 5%, respectively. Likert scores were lower (less important) among frail patients for several objectives (avoiding hospitalization, independence in daily tasks and work: Figure 1B). After 1 year, 65% of patients were hospitalized at least once, 15% transferred to facility hemodialysis, 12% died and 19% were transplanted. "Improve quality of life" tended to be more often selected by patients who died during follow-up (67% vs. 32% for survivors, p=0.06). After adjustment, frail and 'pre-frail' patients (CFS ≥3) had a 4-fold higher risk of the composite outcome vs. fit patients.
Conclusion
Low concordance between patients and clinicians suggests that structured goals-of-care questionnaires may improve individualized home dialysis care. Integrating patient goals, frailty assessment and clinical judgment may improve patient-centered care.