3.9.5.2 Peritoneal Dialysis

Although self–care therapies fulfil the key criteria (i.e. enabling patients to return home), other considerations regarding treatment uptake were communicated to the Study Team – particularly a patient’s perception of:

• The safety of the treatment.
• Their own capacity to carry out the treatment; and related to this.
• The suitability of the treatment for their home situation as they know it.

From the trainer’s viewpoint a range of specific criteria were reported including:

• The motivation and ability of the person to learn the technique.
• A minimum level of English literacy.
• Dexterity and reasonable eyesight,
• A suitable place to undertake the treatment.
• Identified support persons.
• Capacity to manage stores associated with the treatment.

Patients talked about their own network of information, including shared stories of other patients’ experiences. While patients who are doing PD themselves were enthusiastic in pointing out its benefits, the majority of patients spoken to in the IMPAKT study, and during consultation for this Study, were not well disposed to PD. There was concern about the number of infections, the permanent placement of the tube, and particularly perceptions of hyper–cleanliness required by this modality. Many felt it was beyond them.

I was thinking see, I had friends and family was on it – they were older than me. They died, because they probably not cleaning themselves properly you know. I’d like it –but it’s too hard for me. Mmm, cleaning and changing yeah. Yeah, it’s too hard that way and you got to have nice clean house – no kids, little kids around –

Q: Yeah, touching everything.

That’s what I was thinking. Yeah, see I have three grandchildren now; sometime they with me all the time. (IMPAKT Study JD161)

You have to have everything in a good condition for that – it’s no good for desert people, we’re not hygienical, and that – it’s got to be like in a hospital (Home haemodialysis patient, Nov 2010).

In Warburton, where there have been several long–term successful PD patients, there is a more positive attitude to PD from patients, local nursing staff and clinicians. Patients value the speed of returning to country (compared to remaining on metropolitan HD), and the mobility and independence once home. Those patients who were successfully doing PD in the community were receiving a range of support services from the local community. The overall impression of the Study Team is that much effort will be required to overturn negative perceptions of PD in the region.