SO005BARRIERS TO PERITONEAL DIALYSIS IN SASKATCHEWAN CANADA: RESULTS FROM A PROVINCE WIDE SURVEY
Bibliographic record
Abstract
Abstract Background and Aims Peritoneal dialysis (PD) offers similar clinical outcomes to hemodialysis (HD) at a fraction of the cost. PD remains underutilized as remote HD patients in the province of Saskatchewan often relocate or travel hundreds of kilometers weekly in order to receive dialysis related care. Many barriers to patient uptake of PD have been described, but the scale of their impact on our patient population have not been quantified. To improve uptake of peritoneal dialysis in Saskatchewan, we need to address the most prominent barriers to patient access to PD to ensure that they truly have a choice in determining the modality with which they choose to dialyze. The purpose of this study was to determine the barriers to receiving PD in Saskatchewan Method We conducted a cross sectional survey of in-center HD patients across the province of Saskatchewan, Canada. A total of 740 in-center HD patients at two academic sites and 7 satellite units were approached by study coordinators. 421 patients (n=268 in the main units and n=153 in the satellite units) agreed to participate in the study. A questionnaire using a five-point Likert scale was created to identify barriers to PD with questions addressing PD awareness and knowledge, accessibility, and risks, fears, beliefs surrounding PD. Responses were anonymous and tabulated using a data collection tool. Survey data were summarized using descriptive statistics. Results 45.9% of participants had more than 12 years of formal education. 11% lived on farm, 19% on reserve, and 71% in town/city. The median (interquartile range=IQR) distance of home to in-center dialysis units was 10 (5-70) kilometers. Only 82% of patients were aware of PD as a treatment option. 35% of patients felt they had no understanding of the benefits or risks of PD. Despite only 13% of patients being told they were unsuitable for PD by their nephrologist, approximately half (47%) had ever considered it as a treatment option. Prominent barriers to PD that we identified were: excellent care in the HD unit (62%), proximity to dialysis unit (41%), unwilling to dialyze daily (36%), and unwilling to learn a new technique (34%). Beliefs held by patients that figured prominently in their decision to choose HD over PD included not wanting to take their disease home (32%), fear of being a burden on family (32%), lack of space (28%), risk of infection, issues with self-image while on PD, and PD being an inferior modality to HD (all approximately 24%). Conclusion Several barriers to PD were identified with a few consistent themes being identified, including deficiencies in knowledge, patient specific beliefs, poor patient education, and perceived benefits of in-center care (satisfaction with current care). The most frequently reported knowledge barrier was a lack of understanding of benefits and risks of PD. These findings suggest that not enough patients are receiving formal education, or active involvement in deciding which modality they would be most suitable for them when initiating dialysis. To improve uptake of PD in Saskatchewan, we will have to generate both increased awareness of PD as a treatment modality, alongside improved educational strategies to enable patients to make an informed choice about how they receive renal replacement therapy. While the study does not reflect the views of all patients, the information gained will be valuable in designing an educational program to improve adoption of PD within our province.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.006 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".