Remote Management for Peritoneal Dialysis: A Qualitative Study of Patient, Care Partner, and Clinician Perceptions and Priorities in the United States and the United Kingdom

• Main Authors: Lalita Subramanian, Rosalind Kirk, Tony Cuttitta, Nicole Bryant, Kimberly Fox, Margie McCall, Erica Perry, June Swartz, Yanko Restovic, Allison Jeter, Angelito Bernardo, Bruce Robinson, Jeffrey Perl, Ronald Pisoni, Rachel L. Perlman
• Format: Article
• Language: English
• Published: Elsevier 2019-11-01
• Series: Kidney Medicine
• Online Access: http://www.sciencedirect.com/science/article/pii/S2590059519301141

Rationale & Objective: Peritoneal dialysis (PD) is a home-based kidney replacement therapy used by a growing number of patients with kidney failure. This qualitative study explores the impact of remote management technologies on PD treatment priorities of patients, their care partners, and clinicians. Study Design: Qualitative study, designed and conducted in collaboration with a stakeholder panel that included patients, patient advocates, care partners, and health care professionals. Setting & Participants: 13 health care providers, 13 patients, and 4 care partners with at least 3 months experience with PD were recruited from the United States and United Kingdom through postings in PD clinics, websites, and social media. Methodology: Semi-structured telephone interviews with a purposive sample of participants. Analytical Approach: Inductive thematic development adapted from a grounded theory approach through analysis of interview transcripts by 3 independent coders. Results: 4 main themes about PD treatments emerged that enabled evaluation of remote management: (1) impact of PD on everyday life, (2) simplifying treatment processes, (3) awareness and visibility of at-home treatments, and (4) support for managing treatments. The relative importance of these themes differed between patients/care partners and health care providers and by use of remote management cyclers. Limitations: Remote management is new to PD, mirrored in the limited penetration of use in the study sample, suggestive of findings reflecting early adoption. Conclusions: Participants welcomed technological advances such as remote management for PD, although priorities differed by stakeholder group. Remote management could potentially influence health care provider decisions about patient suitability for PD, while patients/care partners prioritized pre-emptive and early treatment adjustments. Currently, decisions about access to remote management are outside the control of patients and families, but this may change with more widespread use. Index Words: Peritoneal dialysis, remote management, qualitative, patient-centered reporting