Home Dialysis for Latinx Individuals Living with Kidney Failure: A Qualitative Study of Interdisciplinary Dialysis Clinicians.

Background: Latinx individuals experience 2 times the incidence of kidney failure compared to non-Latinx individuals and are less likely to utilize 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, semi-structured 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 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.