Home dialysis provides multiple benefits for patients: but there are system and practical factors that are limiting its uptake. In addition, patient and carer misconceptions and apprehensions, if not addressed, can put a brake on patients adopting this option. This is particularly the case in respect of home haemodialysis.
Incentivising patients to dialyse at home requires that the initial messaging of the benefits are fulsome, the support systems are adequate and are in place to overcome patient apprehensions, and the practical impediments at home are overcome.
The manner in which patients and carers are advised about the benefits of home dialysis, and the way in which the pre-dialysis education and training are undertaken can have a major influence on patient and carer choices. These can be readily modified to give encouragement to patients to “go home”.
Patient apprehensions and carer anxieties limit the enthusiasm for home haemodialysis. But assurances to them that home dialysis does not mean they are alone and unsupported will help overcome the view that home dialysis comes at greater risks than in-centre treatment. But assurances need to have meaning: there are a range of matters that clinicians and the system need to do to give these assurances credibility.
Practical matters can be a significant limitation: incentivising patients will require that a range of small but collectively meaningful limitations are dealt with.
Most of these can be readily modified to give patients and their carers confidence that home dialysis, and particularly nocturnal home dialysis, is a suitable approach: the benefits are many and should be grasped enthusiastically.
Bill Handke OAM is a carer for his wife Jenny, who suffers chronic kidney disease and has been on dialysis for 17 years. Over that time he has been heavy involved as a volunteer in renal health matters and in organ and tissue donation promotion and policy advocacy. He has been a member of Kidney Health Australia’s National Kidney Consumer Council since 2003, was the carer representative on the National Home Dialysis Advisory Committee for seven years, and is on a number of community and ACT government committees relating to organ and tissue donation. Bill has been recognised for his community work: he received the Kidney Health Australia Angel Award in 2007, the ACT Chief Minister’s Award in 2009 for organ donation matters, the Environmentalist of the Year for the ACT Region in 2014, and an Order of Australia Award in 2017 for his contribution to community health and the environment.
During his career in the Australian Public Service, he received the National Australia Day Council Award for Achievement in 1998, 2000 and 2001.