Table 3 Challenges and facilitators of establishing HHD and SAHD in Singapore
Factors influencing dialysis modality decision | HHD | SAHD |
|---|---|---|
Environment | ||
Challenges | Home modification requiring approval from relevant authorities Need for a clean home environment and space to store dialysis supplies Presence of adequate medical and technical support systems | |
Facilitators | Performed in-centre hence need for home modifications and space constraints will not be a concern | |
Financial | ||
Challenges | Funding mechanism not explicit as program is not commonly offered and adopted locally Additional cost from power and water usage as well as home modifications Cost of training program | Cost of training program |
Facilitators | Available funding mechanism which is similar to conventional HD as treatment is performed in-centre | |
Family | ||
Challenges | Increased family caregiver burden for patients who are less independent Concerns about caregiver’s competency to perform dialysis | |
Facilitators | ||
Personal | ||
Challenges | Difficulties and apprehension of self-care Concerns of sub-optimal care and increased risk of infections | Difficulties and apprehension of self-care Concerns of sub-optimal care with reduction in manpower in-centre Need for travelling to dialysis centre Fixed time slots |
Facilitators | Greater autonomy, freedom and flexibility Minimal disruption to daily routines Comfort and convenience Option of having more frequent dialysis | Assurance provided by presence of medical staff during dialysis sessions Increased involvement in care |
Social | ||
Challenges | Social isolation | |
Facilitators | Social interactions maintained as dialysis is performed in-centre | |
Information | ||
Challenges | Patients’ knowledge gap of HHD and SAHD Delivery of information on dialysis modalities at an appropriate timing that is tailored to patients’ needs | |
Facilitators | Patients value family, nephrologist and fellow patients’ opinions | |