Abstract
KEY POINTS: In this study of minoritized patients referred to modality education before dialysis, a high proportion selected, but fewer initiated dialysis with, peritoneal dialysis (PD). Those who initiated with PD were younger, healthier, and more responsive to education staff than those who started with hemodialysis. Patients identified lack of emotional support and information about overcoming structural barriers to PD as shortfalls in the education program. BACKGROUND: In a cohort of patients with late-stage kidney disease who completed dialysis modality education and who self-identified as racial ethnic minorities, we studied characteristics of those choosing peritoneal dialysis (PD) and perception of usefulness of the education session in modality selection. METHODS: In this study of individuals with kidney failure cared for by nephrologists at Montefiore Medical Center, Bronx, New York, who were referred for modality education, we (1) tested the association of patient characteristics with modality selection in 113 patients from 2021 to 2023 and (2) examined patient perception of the quality of modality education from 13 semistructured interviews. We compared sociodemographic, clinical attributes, and patient responsiveness to attempts made by staff among those who selected and initiated PD with those who (1) did not select PD or (2) initiated on hemodialysis urgently. We performed qualitative analysis of interviews to reach consensus on theoretical domain framework concepts and how they fit events in the kidney failure trajectory. RESULTS: Compared with individuals who required urgent hemodialysis, those who selected and were initiated on PD were younger (54 versus 66 years), had fewer comorbidities, and did not require as many attempts to schedule modality education. Qualitative analysis of interviews showed that experience with staff and quality of information conveyed during education was generally positive, but the following gaps were identified: lack of support for the emotional trauma of kidney failure diagnosis, inability to address structural barriers to PD specific to the patient population, and the lack of a deliberate program to lessen anxiety about the responsibility of PD. CONCLUSIONS: Incorporation of tailored content that addresses clinical comorbidity, structural barriers to care, and emotional trauma constitute aspects of modality education that can be improved to increase PD uptake among minoritized patients.