Nocturnal home hemodialysis (NHHD) has been shown to improve clinical outcomes, although adoption has been limited. Given the known benefits, an understanding of the barriers to adoption is needed. Cafazzo and coworkers studied patient-perceived barriers through a cross-sectional survey of prevalent hemodialysis patients using validated instruments, study-specific questions, and ethnographic interviews. Fifty-six of 66 NHHD patients and 153 of 199 conventional hemodialysis (CHD) patients were included in the survey. Twenty interviews were conducted with NHHD, CHD, and predialysis patients. Compared with CHD patients, NHHD patients had higher perceived physical health scores, but had similar mental health scores. Despite having similar measures of education and perceived social support as NHHD patients, CHD patients had a low interest in adopting NHHD. The major barriers perceived by CHD patients were lack of self-efficacy in performing the therapy, lack of confidence in self-cannulation, and length of time on current therapy. Similar themes emerged from the qualitative analysis as well as: burden on family members and fear of a catastrophic event.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that patient-perceived barriers are primarily fears of self-cannulation, a catastrophic event, and the burden on family. These findings should form the basis of screening patients for interest in NHHD and serve to mitigate these concerns.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: It is likely that all patients with a chronic illness have perceived barriers to using new techniques and skills. If you think of any barriers you have to undertaking self-management training, for example, you should discuss these with your health care provider or with those conducting the training program. Eliminating any barriers, real or imagined, will enhance your training and later performance of the skills you learn.

JA Cafazzo et al. Patient-Perceived Barriers to the Adoption of Nocturnal Home Hemodialysis. Clinical Journal of the American Society Nephrology, April 1, 2009.