Three Ways to Empower Patients to Try Home Dialysis
Home dialysis allows a patient to perform dialysis treatments by themselves or with the support of a care partner in the comfort of their own home. It allows for more flexibility and other benefits that can improve quality of life, including treatments at night or more frequent treatments, consistent with their physician's dialysis prescription. The two options for home dialysis are peritoneal dialysis (PD) and home hemodialysis (HHD), both of which allow patients to perform dialysis in their own home.
How do the care teams at Fresenius Kidney Care empower their home dialysis patients? Michael Kraus, MD, FACP, Associate Chief Medical Officer of Fresenius Kidney Care, outlines three ways to empower home dialysis patients.
1). Encourage Motivation to Succeed
“Who does best on home dialysis?” I have been asked this question quite often over the last 17 years, and I have to say that almost any patient with end stage renal disease and the motivation to succeed can be the ideal patient.
By being honest up front, setting expectations, and giving assurance of safety, we can help patients to develop motivation. With motivation, and enough support, almost anyone could be an ideal candidate to thrive while dialyzing in their home.
I look to recognize a patient's motivation, and I work on how we can treat them and how we can make it easier for them to succeed at home. Almost all patients can do well, but it's incumbent on the patient to have the motivation to succeed and be adherent. And it is essential for us, as the care team, to have the engagement to figure out how best to teach the patient and help them through whatever barriers they have.
2). Individualize care for each home
Each patient is different. While traditionally, the "home" in home dialysis is a single-family home or an apartment, the definition is expanding to be anywhere the patient chooses: a private residence, a travel destination, a skilled nursing facility, or even a community center. While dialysis in the actual home will remain the primary site of home therapies, the concept of a home will evolve. It is incumbent upon us to provide guardrails to ensure quality and safety in all of these settings.
Knowing this, we need to take into account all the things for each type of home and together with patients figure out how to manage the storage of supplies. Also, we need to make sure that while the whole house doesn't have to be perfectly clean, where a patient does dialysis has to be clean. By working with each patient on managing their care in their own space, we can enhance their experience on home dialysis.
3). Empower the support system
We must understand the family dynamics or the support system for each patient. A good home dialysis program engages the support system in addition to the patient. For example, I once had a patient on in-center dialysis who was about 78 years old. She did not speak English and had cardiac, mobility, and cognitive issues. Additionally, she was not eating. She was the kind of patient who may be viewed in-center as having a long-term survival somewhere between two and six months.
I had a conversation about options of care with the patient and the family. The family said, “We want to do whatever it takes to try and make mom better.”
This patient was an ideal candidate for home dialysis; not too sick to go home, and sick enough to greatly benefit from home dialysis.
The family agreed to try more frequent dialysis at home, and with their support, she thrived on home hemodialysis for 9 years. Her health greatly improved, both physically and mentally. She no longer needed blood pressure medication, and she even began to walk again. By working with her family, and encouraging them to help with home dialysis, that patient saw a great improvement in her quality of life.
Stories like this are why I believe that every patient should be empowered to do their dialysis treatments at home, which can lead to a higher quality of life.
Comments
Linda McKenney
Mar 17, 2022 1:39 PM
I've said from the time I started dialysis that the goal should be self care either in center or at home for every new patient. Self cannulation should be encouraged and accepted. That wasn't the case at my clinic even when I asked to self cannulte. Instead of having the machine set up and ready to go when the patient comes in set it up and talk through the steps encouraging the patient to take over. Ideally new patients would see most other dialyzers setting up, cannulating and running their treatment. Encourage patients to respond to their own alarms.
Even if they never opt for home treatment encouraging self care would be so empowering. I'm amazed at the number of dialyzers who come to dialysis groups to complain that staff took off too much fluid and won't accept any responsibility. Too many patients don't know their BFR or DFR even after extended time on dialysis.
Henning Sondergaard
Mar 11, 2022 12:07 PM
I have a few comments. When you talk about motivation I totally agree that we need to look at who is motivated to do home treatment. But I see in my country it is equally important to look at staff and their motivation to send people home. Alas, it is virtually non-existing in far too many places. Even today I saw on the HDC facebook page that an American person was denied doing home solo "because it was illegal in their state" whether this is true or not, it is also a sign of unmotivated staff who are unwilling to help someone live a freer and more self-sufficient life. And that saddens me greatly. I know as a fact I would not have been alive now if not for doing home treatment. And I know, the day I am forced to go in-center I need to seriously consider if it's worth living at that point, this is not to whine or anything but a statement of fact, I have seen enough of the inside of hospitals and clinics to not want to do so 3 times a week.
I think the main problem in getting people home is poor training. Everyone trained in dialysis use, from techs to doctors, ought to have intensive training in home care so they are better able to recognize all those who could benefit from such an option. We are not changing the present ways until we change the way people act and think.
It pains me to say I truly think the biggest barrier for home is staff. It only takes one professional to keep a patient from doing their own treatment at home by instilling fear or the idea of being inadequate in that patient. And it's way too easy to do so while the patient is experiencing the greatest crisis of their life (as an authority figure you can tell such a person the moon fell out of the sky and they will believe you) and it takes a whole well trained team to remove the fear again once it's created.
So proper education of both staff, patients and potentially family is of the essense. And it all ought to start in the colleges and universities for doctors and nurses. If not, the uphill battle will continue way longer than we care to think.