Social Environment of Patients and Dialysis Units, Patient Activation and Behaviour
Authors: Delon Michelle , Dassanayake Thushara , Allen Kerry , Barnes Tania 
Published: May 2024

How does a patient's social living environment affect their health behaviours? Similarly how does our organisational environment of in our dialysis centres affect their performance? How do we develop partnerships in care to improve patient activation about their dialysis treatment?

Schedule:

1. 09:15-10:00 Living on Dialysis in Poverty and Food Choice
2. 10:00-10:30 What Characterised a High Performing Home Therapies Unit? Findings from Inter-CEPt
3. 10:30-11:00 "Passenger or Participant?" ShareHD

Living on dialysis in poverty and the impact of nutrition.

Poverty is multi-dimensional and encompasses health, education, standard of living, food security, social connections and housing quality. Poverty has been associated with multiple risk factors for kidney disease including hypertension, diabetes and obesity and multiple studies have documented an association of poverty with kidney disease. In the UK around 1 in 5 of the population are living in poverty.
In renal medicine we have the privilege of working with people over long periods of time so the relationship between medical and psycho-social care professional and patient has the potential to be well established and trusted. This gives us a unique insight into the patient needs and the opportunity to address these through a systems approach.

How does organisational culture facilitate uptake of home dialysis? An ethnographic study of kidney centres (Inter-CEPt)

Despite guidance encouraging greater home dialysis use in England uptake rates have not increased. Uptake by centre varies considerably, suggesting that the organisational cultures of kidney centres may be important.

This is the first ethnographic study of kidney centre culture focussed on home dialysis uptake. Ethnographic research was conducted at four case-study sites, with average or high rates of home dialysis use. Data were collected through observations of consultations, patient education sessions and training (n=34); and interviews with staff, patients, and carers (n=72).

The NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) framework was used to map factors that influence patient decisions about dialysis. We identified three themes that facilitated confidence in home dialysis:

- a) Encouraging patient voice and individualised support. Teams engaged with people’s psychosocial needs and cultural contexts, and valued peer support as part of patient education;

- b) Ensuring access to home dialysis. Transparency about all treatment options and minimisation of eligibility assumptions;

- c) Achieving sustained change based on benefits for patients. This included organisational cultures that adopted quality improvement approaches and worked with wider stakeholders to shape future policy and practice. Treatment decisions relied on patients and carers placing confidence in their kidney care teams.

This assessment of kidney centre culture has identified relevant approaches to patient education, access to treatment and readiness for improvement and change.

"Passenger or Participant?" ShareHD

For information about Tania Barnes work with Shared Haemodialysis Care, please click [here](https://www.shareddialysis-care.org.uk/).