Strategies to Encourage Uptake of Self-Care for Haemodialysis Patients in Leicestershire

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STRATEGIES TO ENCOURAGE UPTAKE OF SELF-CARE FOR HAEMODIALYSIS PATIENTS IN LEICESTERSHIRE

Chuah CK 1*,Pudge G 1*, Sheikh N 1*, Taneja S 1*, Baines RJ 2, Burton JO2

1 Department of Medical and Social Care Education, University of Leicester, Leicester, UK.2Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.*Authors with the (*) should be considered as joint first authors.

INTRODUCTION: Research has shown that increasing patient participation in dialysis can improve patient outcomes, experience and quality of life. Although self-care dialysis is recommended by NICE,in-centre haemodialysis (ICHD) is often led by healthcare professionals; they are largely responsible for preparing and monitoring patients with little involvement from the patients themselves. We sought to investigate if patients felt fully informed of different treatment options and whether there was a desire to change their current arrangements.

AIMS: To assess patient satisfaction with pre-dialysis counselling and consideration of the patient’s choice of renal replacement therapy (RRT). To identify patients receiving ICHD who would be willing to engage in self-care dialysis.

METHODS: Quantitative data were collected anonymously from patients utilising a questionnaire from 3 ICHD units at a single given time point. Data included demographic information andpatient satisfaction with: pre-dialysis counselling, original choice of RRT and current ICHD arrangements. If interested in changing current arrangements, patients were asked to consider alternative forms of therapyand rank those of interest in order of preference.

Results: Of the 388patients treated at the three units, a total of 247 (64%) completed the questionnaire. Patient distribution by age and sex showed little variation between the units. Key findings are shown below:

Satisfaction with current haemodialysis (HD) services / n (% of total surveyed population)
Felt well-informed of various RRT modalities before making an informed choice / 200 (82.0)
Fully discussed options in pre-dialysis clinic / 204 (84.3)
Started on preferred choice of RRT / 202 (82.5)
Would consider changing current arrangement / 120 (48.6)
Interest in self-care dialysis / n (% of those dissatisfied) / Ranked as top choice (n)
Peritoneal dialysis / 20 (17.0) / 6
Home HD / 34 (28.8) / 17
Self-care ICHD / 42 (35.6) / 12
Self-care community HD in minimal care facility / 82 (69.5) / 51

CONCLUSIONS: Nearly half of ICHD patients surveyed considered making a change to their current dialysis arrangements. Of those patients, only a third were willing to get more involved with their dialysis on the ICHD unit despite a large percentage being interested in self-care in the community. This indicates a lack of patient understanding concerning the commitment to community dialysis, a recognised problem. We recommend implementing a step-wise education programme aiming to move patients into the community, beginning with patient-led care on the ICHD unit.