Psychosocial Barriers to Home Dialysis: A Literature Review

This review of 35 research and anecdotal reports discussing psychosocial barriers to home dialysis explores the challenges and successes of home dialysis from the viewpoints of both patients and nephrology professionals. The literature identified multiple psychosocial barriers to successful home dialysis: physical ability, cognition, patient attitudes toward home dialysis, emotional impact on the patient, emotional impact on the family, support from family, whether patient or caregiver is responsible for treatment, time constraints, patient personality and mental health, safety and patient’s adherence with procedures, suitability of patient’s home and willingness to change it, cultural issues, language barriers, unplanned start on dialysis, policy differences between modalities, loss of relationships with staff and other patients, support from staff for home dialysis, knowledge barriers, cost to hospital/staff availability to train and maintain home dialysis patients, and cost to the patient. Assessment tools already exist. The Jo-Pre-training Assessment Tool (JPAT) is a screening instrument which assesses the suitability of candidates for home dialysis, either peritoneal dialysis (PD) or home hemodialysis (HHD). It is designed to identify health-related problems; candidates are then referred to the appropriate professionals among the multidisciplinary team for assessment and care before starting training. The Method to Assess Treatment Choices for Home Dialysis (MATCH-D) was also developed to assess patients’ suitability for home dialysis (PD or HHD), screening for medical and social barriers. However, we were not able to find a comprehensive tool specific to psychosocial barriers experienced by patients and their families. Based on the literature review, we concluded that psychosocial aspects are significant factors influencing the patients’ ability to maintain home dialysis. To this end, the authors are developing a new tool: the Psychosocial Assessment Tool for Home Dialysis (PATH-D).