Abstract
KEY POINTS: Individual-level advocacy to overcome structural barriers to home dialysis is key in improving home dialysis access for Latinx individuals. Acknowledging patient influences on dialysis modality choice is critical for Latinx individuals with kidney failure. Early, repeated education from a trusted source is important for Latinx individuals with kidney failure. BACKGROUND: Latinx individuals experience two times the incidence of kidney failure compared with non-Latinx individuals and are less likely to use home dialysis therapies. In this qualitative study, interdisciplinary home dialysis clinicians were interviewed to understand the key factors and strategies used by clinicians to improve home dialysis uptake among the Latinx community. METHODS: One-to-one, semistructured interviews were conducted between November 2021 and March 2023 with 25 home dialysis interdisciplinary clinicians in Denver, Colorado, and Houston, Texas. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS: We identified three themes that focus on different levels of clinician advocacy in home dialysis uptake for the Latinx community: (1) individual patient-level advocacy (helping patients overcome social challenges to home dialysis, cultivating personalized relationships, educating patients with in-person versus phone language interpretation, understanding cultural differences in communication), (2) understanding patient influences on modality decision-making (acknowledging the importance of cultural concordance with clinician educator and patient peers, incorporating the patient lived experience, connecting with a patient's social support network, highlighting greater flexibility for employment, underscoring flexibility with culturally concordant foods), and (3) changes to education at the dialysis facility level (standardizing routine and repeated modality education, promoting early and patient-centered education). CONCLUSIONS: Clinicians outlined efforts to improve access to home dialysis for Latinx groups on the patient and system level; in particular, individual-level and system-level advocacy was grounded in trusting relationships and personalized education. A future intervention that improves the quality and personalization of dialysis modality education incorporating Latinx cultural values may improve access to home dialysis for Latinx people with kidney disease.