Study paves the way for more personalised haemodialysis care
Results from a pioneering collaborative trial have highlighted the potential benefits of empowering dialysis patients to be active partners in their own care.
Studies have shown that home haemodialysis is associated with better survival and quality of life. However, since haemodialysis was first developed, there has been a shift from most kidney patients undertaking the procedure at home, to the majority of patients visiting dialysis centres where their treatment is often carried out entirely by healthcare providers.
There is strong evidence that patients with long-term health conditions have better outcomes if they are involved in their own care, and some of the benefits experienced by patients who dialyse at home could be put down to the increased knowledge, skills and confidence that come with managing their own condition.
Shared Haemodialysis Care trial
A team of researchers at the University of Sheffield and Sheffield Teaching Hospitals created an educational quality improvement initiative called Shared Haemodialysis Care to try to increase the number of dialysis patients who are given the chance to participate in their own care.
This programme involves breaking the haemodialysis process down into roughly 14 steps, ranging from more simple tasks such as measuring blood pressure, pulse and weight, and hand hygiene, through to more complex tasks such as inserting needles and programming the dialysis machine. Patients are educated and supported in how to carry out these steps so that they can participate in as many or as few tasks as they are comfortable with.
With support from the Health Foundation, Kidney Research UK and Kidney Care UK, and with the help of patient partners to steer the work, the team, led by Professor Martin Wilkie, carried out a collaborative trial with 586 haemodialysis patients across 12 UK renal centres. The trial, called SHARE-HD, was designed to test whether educating and training patients in dialysis tasks could increase the proportion of patients doing five or more tasks by themselves, or choosing to switch to home haemodialysis.
The results, published recently in the journal PLOS ONE, showed that the proportion of patients performing five or more tasks or home haemodialysis increased from 45.6% to 52.3%, but this change was not significant when adjusted for time. The number of patients choosing to dialyse independently in centre or at home increased significantly from 7.5% to 11.6%.
The programme had the greatest impact on patients who were doing fewer tasks at the start of the study and on patients who were new to dialysis, highlighting the importance of involving patients in their own care right from the start.
Although the concept of patients having an active role in their own care is simple, it requires a change in conventional healthcare delivery and mindset. This programme offers a realistic and straightforward pathway to empowering patients to have an active role in their own care, and with further research this is likely to lead to improvements in confidence, survival, and quality of life for many patients.
Martin commented: “This quality improvement initiative delivered by teams from multiple UK sites showed that many of those who dialyse at centres, when given the choice, opportunity and support to do so, will take on aspects of their own treatment. For some that will lead to choosing to dialyse independently in centre or at home.”
Michael Nation, director of development at Kidney Research UK commented: “It was great to be part of the pioneering team that helped to shape and run the SHARE-HD programme across so many sites in the UK. I was fortunate enough to be able to bring over 10 years of development experience from other quality improvement projects and it’s clear that the results have helped to show that right from the start a more personalised and involved care approach can deliver clear advantages for dialysis patients. I look forward to working with everyone on building on the results achieved for the future benefit of more kidney patients.”
The team continue to run a website to support Shared Haemodialysis Care that includes information on a training course for health care staff.