Influences on dialysis modality choice among African American and Mexican American individuals with kidney failure and their care partners: A qualitative study

Abstract

Rationale and Objective

Compared to in-center hemodialysis, home dialysis may better address the needs of some individuals with end-stage kidney disease (ESKD). However, home dialysis utilization is lower in African American and Hispanic individuals with ESKD. We sought to identify the factors that most influence dialysis modality choice, specifically home dialysis, in these individuals and their care partners.

Study Design

Qualitative research study using focus groups.

Setting and Participants

Fifty-seven participants, including African American and Spanish-speaking Mexican American individuals on dialysis (both in-center and home) and care partners, were recruited to in-person focus groups in five US metropolitan areas. Mexican American focus groups were held in Spanish language and translated in real time by a certified interpreter; recordings for all focus groups were transcribed verbatim for analyses.

Analytical Approach

Participant responses were analyzed using inductive thematic analysis techniques.

Results

Physician guidance was cited as the most important factor in making the initial modality decision for all groups. African American respondents primarily relied on healthcare professionals for information, but also seek independent validation (e.g., “trust but verify”). Mexican American respondents stated that trust in physician recommendation is largely unquestioned, influenced by factors such as cultural respect for physician authority, limited literacy, and language barriers. African American respondents desire additional education about modalities, particularly when they feel ready to comprehend content (sequenced to recognize how overwhelming it can be at the initial diagnosis of kidney failure). Although most individuals on dialysis and their care partners acknowledged the clinical benefits of home dialysis, significant barriers to choosing a home modality included the fear of being solely responsible for a complex procedure and loss of social interaction and/or support from other individuals on dialysis and center staff.

Limitations

As the focus groups were all conducted in metropolitan areas, the transferability of the findings to other settings is uncertain.

Conclusions

Improved educational programs on dialysis modality choice should build on the strong preference for physician-led health information to better address educational needs of African American and Mexican American individuals facing the choice of a dialysis modality. Tackling issues pertaining to understanding kidney disease pathogenesis and addressing trust in healthcare professionals is necessary in African American individuals. In Mexican American communities, specific emphasis should be placed on addressing literacy and language barriers. Home dialysis educational material for both groups should also incorporate content regarding concerns about safety and social isolation.