In‐Center Dialysis Patients' and Staff Perspectives of Assisted Home Hemodialysis: A Three‐Phase Feasibility Study
Bibliographic record
Abstract
BACKGROUND: The majority of growth in the rising dialysis population remains within in-center hemodialysis, stretching capacity. Despite national strategies promoting home hemodialysis, uptake remains low. Assisted home hemodialysis may overcome challenges by supporting patients who wish to dialyse at home but require assistance. This study aimed to evaluate the feasibility, interest, and operational implications of assisted home HD through multi-modal data collection amongst prevalent in-center HD patients and staff members. METHODS: A feasibility study incorporating patient surveys, focus groups, and care model development was conducted recruiting from three renal centers in the United Kingdom. Outcomes measured utilized structured patient questionnaires to assess patient perspectives, interest in assisted home HD, and assistance needs. Focus groups explored barriers and concerns regarding delivery. Hypothetical cost modeling was estimated. FINDINGS: Four hundred and sixty-five in-center hemodialysis patients from three UK centers participated, with a median age of 66 years. 34% of patients, a significantly younger (p < 0.01) group with higher disability (p < 0.05), answered "yes" when asked if they would consider a switch to assisted home HD, compared with 44% who answered "no", and 22% were unsure. Patients expressed varying degrees of assistance needs across dialysis tasks, with cannulation (65%), machine connection (51%), and set-up (38%). Patients voiced concerns about safety during home treatment and missing social aspects of in-center care, though many also expressed a desire for greater autonomy. Five key themes emerged around staffing practices in implementing assisted home HD, which included (i) boundaries of care, (ii) staff training and supervision, (iii) staff responsibility, (iv) back-up and support requirements, and (v) implementation strategies. CONCLUSIONS: Assisted home HD demonstrates a feasible and desirable option for in-center dialysis patients. Assisted home HD presents as a potential model for overcoming barriers to home HD adoption by prevalent HD patients. Assisted home HD care models should explore varying levels of assistance at home. The findings of this study merit further exploration through implementation pilots and outcomes-based studies.
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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 | 0.011 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".