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Although it has been said that patients choose home hemodialysis (HHD) because they feel better and achieve better outcomes, in reality they cannot appreciate those benefits before they start HHD. Therefore, it is more likely that most patients choose HHD because they aspire to enjoy a better quality of life (QOL). Patients continue on HHD therapy because their perceived benefit outweighs their obligate burden of performing HHD at home. The burden begins with making the difficult decision to take on the responsibility of performing HHD. The home dialysis staff needs to ensure that during the modality education period, patients receive sufficient time and support to mitigate the stress of choosing the best dialysis modality that will enable them to realize their life plans. The staff also needs to be certain that patients have appropriate skills, home environment, and support to succeed on HHD. Plans must be made to correct modifiable barriers for success. Unmodifiable barriers must be identified, recognized, and explained to the patient who is not suitable for HHD.
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The burden of training for HHD should not be underestimated. It requires a significant time commitment on behalf of the patient and, if pertinent, the care partner. Learning new terminologies and procedures that in all likelihood are very foreign to the patient and partner is very stressful. However, the training period is also an opportunity to improve patient benefit and decrease the burden of therapy. The home dialysis team has the undivided attention of the patient and therefore can develop a personal and trusting relationship. The staff has the opportunity to learn more about the patient’s home environment, daily schedule, and life plans that will help inform decisions regarding a preferred treatment duration and schedule. Learning more about the patient’s personality, perceived strengths, and fears will help the staff understand how to relate better to patient needs.
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Fundamental to successful relationships between staff and patients is communication. It is only effective if the participants agree to nonjudgmental, unconditional, and mutually respectful communication. That is to say, patients should feel comfortable enough to tell healthcare providers about any problems, errors, and concerns without fear of reprimand for not following instructions or plans, or fear that they will not be heard and problems will be dismissed. The staff must assure the patient that the focus of the program is the patient and that the staff is only concerned about their health, safety, and well-being. They also need to guarantee that patient complaints will be acknowledged and validated, and that if a solution cannot be provided, other healthcare providers will be consulted. However, the patient needs to understand that at times they may need to receive constructive feedback that is aimed to optimize their treatment and achieve the best outcomes possible.
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There are different ways to define the “ideal patient.” It could be the patient who would ...