Self-care dialysis (SCD) is associated with cost savings and possibly improved quality of life compared to in-center hemodialysis. Despite this, less than one in four dialysis patients are currently treated with SCD. The objectives of a study by McLaughlin and coworkers were to identify perceived advantages of SCD associated with increased odds of selecting SCD, and to evaluate the effect of an educational intervention on patients' perceptions of these advantages. The investigators randomized patients with GFR<30 ml/min to standard pre-dialysis education or to a multifaceted educational intervention. After each component of the intervention, participants completed a questionnaire on which they identified advantages of SCD and indicated their preferred dialysis modality. Inductive coding was used to identify perceived advantages of SCD. Seventy patients participated in the study. Three advantages of SCD were identified: freedom, lifestyle, and control. Of these, freedom and lifestyle were associated with increased odds of selecting SCD (9.1 and 7.0, respectively). These advantages were combined for receiver-operating characteristic (ROC) analysis to assess accuracy in predicting patients' intended choice of dialysis. The area under the ROC curve was 0.82. Patients who received the educational intervention were more likely to perceive freedom and control as advantages, and were less likely to identify no advantages of SCD.

VALUE OF STUDY TO YOU AS A HEALTH CARE PROVIDER: Patients who identified freedom and lifestyle advantages of SCD were more likely to choose SCD. Providing additional education on dialysis modalities increased patients' perceptions of the advantages of SCD and the odds of them selecting SCD.

VALUE OF STUDY TO YOU AS A PATIENT: Self-care or self-management skills used in self- dialysis provide freedom, control, and lifestyle advantages to patients. It puts you in charge of your condition and, to a considerable extent, its consequences. Hopefully, programs are available to teach you about self-care dialysis. If not, ask your health care provider to provide you with knowledge about your condition and, equally important, teach you the skills necessary for you to control your dialysis treatments.

K McLaughlin et al. Why do patients choose self-care dialysis? Nephrolology Dialysis Transplantation, June 24, 2008.