Transportation insecurity significantly affects dialysis care, yet little research examines its impact from both patient and provider perspectives. This qualitative study explored how transportation challenges influence the experiences of patients receiving in-center hemodialysis and dialysis clinic staff. We conducted 78 semi-structured interviews with patients (n = 49) and staff (n = 29) across four Northern California dialysis clinics. Participants described challenges of navigating two systems, healthcare and transportation, and how this creates emotional distress for patients and staff, disrupts clinic workflows, and compromises treatment adherence. Transportation services are a major part of the patient and staff experience in dialysis clinics. Our findings highlight the need to improve transportation for dialysis patients through collaboration between healthcare systems, transportation providers, and community stakeholders.
Understanding regional variation in early transplant access informs tailored interventions. Two comparable surveys assessed perceived access barriers among dialysis and transplant center staff across New England, New York, U.S. Southeast, and Ohio River Valley (August 2021-October 2023). Among 630 dialysis and 34 transplant staff/centers, dialysis staff most often cited patient disinterest (48.75%), transportation challenges (44.75%), and lack of support (37.87%). Transplant staff cited lack of support (74.35%), non-adherence (52.36%), and disinterest (49.03%). Dialysis staff ranked disinterest highest in New York and Ohio River Valley, and transportation challenges highest in the Southeast and New England. Transplant staff ranked anxiety/fear about the transplant process highest in New York, and lack of support highest elsewhere. Regionally tailored strategies are needed to improve access.
This study describes how U.S. dialysis patients with obesity experience trauma and manage it and co-occurring chronic diseases. We interviewed 40 adult hemodialysis patients and 20 physicians and dietitians. Transcripts were inductively coded using trauma theory. Patients described trauma that impacted their ability to manage co-morbidities. Providers characterized patient trauma and their own vicarious trauma while working in dialysis care. Nearly all patients reported trauma, most with characteristics of chronic, emotional, and/or medical trauma, and many described trauma from systems and vicarious trauma across relationships. Complex intersecting trauma exacerbates chronic disease burdens and may impact treatment effectiveness, successful management of co-morbidities, and patients' relationships. Results demonstrate the need for trauma interventions within chronic disease treatment and community settings.
Little is known about the attitudes of renal healthcare professionals (HCPs) toward deceased donation. We surveyed 222 renal HCPs from 12 dialysis units in southeast Michigan about their attitudes toward organ donation as part of a cluster-randomized, intervention study. Factor analysis identified three subscales: general benefits (alpha .88), general barriers (alpha .80), and staff dialysis barriers (alpha .79). We compared subscale values with two variables: enrollment status in the state donor registry (DR) and intentions for future DR enrollment. Higher scores on all three scales were positively associated with DR enrollment. Mean scores varied by HCP role within the dialysis unit. Tailoring donation education to a role and focusing on the benefits may have an effective impact on HCP attitudes. Results from this study can inform future interventions to improve promotion of organ donation amongst professionals working in dialysis units.
