Why do patients choose self-care dialysis?

Background. Self-care dialysis (SCD) is associated with cost savings and possibly improved quality of life compared to in-centre haemodialysis. Despite this, less than one in four dialysis patients are currently treated with SCD. Our objectives were to identify perceived advantages of SCD associated with increased odds of selecting SCD, and to evaluate the effect of an educational intervention on patients' perceptions of these advantages. Methods. We randomized patients with GFR < 30 ml/min to standard pre-dialysis education or a multifaceted educational intervention. After each component of the intervention, participants completed a questionnaire on which they identified advantages of SCD and indicated their preferred dialysis modality. We used inductive coding to identify perceived advantages of SCD. Results. Seventy patients participated in the study. We identified three advantages of SCD: freedom, lifestyle and control. Of these, freedom and lifestyle were associated with increased odds of selecting SCD [OR 9.1 (2.0, 41.3) and 7.0 (1.6, 29.7), respectively]. We combined these advantages for receiver-operating characteristic (ROC) analysis to assess accuracy in predicting patients' intended choice of dialysis. The area under the ROC curve was 0.82 (0.70, 0.93). Patients who received the educational intervention were more likely to perceive freedom and control as advantages, and were less likely to identify no advantages of SCD. Conclusion. Patients who identify freedom and lifestyle advantages of SCD are more likely to choose SCD. Providing additional education on dialysis modalities increases patients' perceptions of the advantages of SCD and the odds of them selecting SCD.