{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:54:25Z","timestamp":1787871265733,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"name":"VA Centers of Innovation and Innovators Network","award":["LOL XVA 42-033"],"award-info":[{"award-number":["LOL XVA 42-033"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2021,12]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Several challenges and facilitators for home dialysis implementation were found and aligned with attitudes and perceived behavior control.<\/jats:p>\n <\/jats:list-item>\n \n Many novel recommendations from diverse stakeholder groups (patients, caregivers, dialysis staff) for home dialysis implementation emerged.<\/jats:p>\n <\/jats:list-item>\n \n Findings reveal factors that future research or implementation efforts should address and\/or incorporate into home dialysis care.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Home dialysis confers similar survival and greater quality of life than in-center hemodialysis for adults with ESKD but remains underutilized. We examined challenges and facilitators to implementation of home dialysis and identified stakeholder-centered strategies for improving it.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a qualitative, cross-sectional, multisite evaluation that included five geographically dispersed Veterans Health Administration (VHA) home dialysis programs. Participants included patients with ESKD receiving home dialysis, their informal caregivers, and home dialysis staff. Semistructured telephone interviews were conducted and audio-recorded from 2017 through 2018, to assess perceived barriers and facilitators to patient home dialysis use in VHA. Transcribed interviews were analyzed thematically by each participant group.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants included 22 patients receiving home dialysis (18 on peritoneal dialysis [PD] and four hemodialysis [HD]); 20 informal caregivers, and 19 home dialysis program staff. Ten themes emerged as challenges to implementing home dialysis, of which six (60%) spanned all groups: need for sterility, burden of home dialysis tasks, lack of suitable home environment, physical side effects of home dialysis, negative psychosocial effects of home dialysis, and loss of freedom. Four themes (40%), identified only by staff, were insufficient self-efficacy, diminished peer socialization, geographic barriers, and challenging health status. Twelve themes emerged as facilitators to implementing home dialysis, of which seven (58%) spanned all groups: convenience, freedom, avoidance of in-center HD, preservation of autonomy, adequate support, favorable disposition, and perceptions of improved health. Two themes (17%) common among patients and staff were adequate training and resources, and physical and cognitive skills for home dialysis. Recommendations to promote implementation of home dialysis common to all participant groups entailed incorporating mental health care services, offering peer-to-peer coaching, increasing home visits, providing health data feedback, and reducing patient burden.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Stakeholder-centered challenges were rigorously identified. Facilitators and recommendations can inform efforts to support home dialysis implementation.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000642021","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T09:55:13Z","timestamp":1640858113000},"page":"1928-1944","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Challenges, Facilitators, and Recommendations for Implementation of Home Dialysis in the Veterans Health Administration: Patient, Caregiver, and Clinician Perceptions"],"prefix":"10.34067","volume":"2","author":[{"given":"Lindsey A.","family":"Jones","sequence":"first","affiliation":[{"name":"Veterans Affairs Information Resource Center, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa J.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Surgery-Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy P.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Hospital, Bedford Veterans Affairs Medical Center, Bedford, Massachusetts"},{"name":"Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindi A.","family":"Fiandaca","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget M.","family":"Smith","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Stroupe","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7316-1719","authenticated-orcid":false,"given":"Michael J.","family":"Fischer","sequence":"additional","affiliation":[{"name":"Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois"},{"name":"Medical Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois"},{"name":"Medicine\/Nephrology, University of Illinois at Chicago, Chicago, 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