"Who matters most?": Clinician perspectives of influence and recommendation on home dialysis uptake. Issue 12 (16th November 2017) - Walker, Rachael C
ABSTRACT: Aim: There is little research exploring the association between clinicians' behaviours and home dialysis uptake. This paper aims to better understand the influence of clinicians on home dialysis modality recommendations and uptake. Methods: Online survey of all NZ renal units to determine the influence of individuals within pre‐dialysis teams. We used the self‐declaration scale of influence to rate the identified member's perceived influence on decision‐making. We used this measure of 'decisional power' to compare the perceived influence of pre‐dialysis nurses with nephrologists using both parametric and non‐parametric methods. We developed a generalized linear model to investigate the relationship between the influence of nephrologists and pre‐dialysis nurses with home dialysis uptake by individual centre using additional data from Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Finally, respondents rated the importance of a list of patient and service‐level factors in recommendations for home dialysis. Results: Data suggest the nephrologists are the most influential member of the pre‐dialysis team. This contrasts with perceptions of survey respondents who view pre‐dialysis nurses as most influential. Nephrologists' recommendations are likely to be a successful way of increasing home dialysis. A single point increase in nephrologist decisional power is associated with a 6.1% increase in the prevalence of home dialysis. Conclusion: The decisional power around home dialysis in NZ sits with nephrologists. It is therefore critical that nephrologists exercise their decisional power in advocating home dialysis and address reasons why they may not recommend home dialysis to well‐suited and appropriate patients. Summary at a Glance: This paper provides powerful information regarding the hierarchy of influence in patients' decisions regarding home dialysis. It comes from a country with a heavy emphasis on home treatment and provides important stimulus to units regarding the critical need to engage clinicians in actively promoting home therapy choices.