Abstract
Background: Patients undergoing hemodialysis often remain passive, with providers performing most treatment tasks. While patient participation can improve safety and care quality, its implementation is limited. This study explores patient and provider perspectives on participation, focusing on organizational factors influencing adoption. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we examined barriers and facilitators to shifting from a provider-dominant model to a shared-care approach.
Methods: A mixed-methods study followed a sequential design. First, a cross-sectional questionnaire was administered to 339 patients across two hospital- and two community-based units. It assessed patient interest and participation in care tasks, examining associations with unit and patient characteristics using logistic regression. Second, 36 semi-structured interviews with healthcare providers and administrators were conducted. These explored perceptions of patient participation using the EPIS framework’s inner context constructs. Qualitative data were analyzed thematically using Atlas.ti.
Results: Most patients expressed interest in participation, yet only 40% actively engaged. Factors influencing participation included unit type, venous access, and years on dialysis, with hospital-based units showing higher participation levels. The qualitative phase identified more barriers than facilitators, including safety concerns, rigid protocols, and the need for staff training. Community units faced stricter regulations, while hospital units provided more autonomy. Experienced nurses were more supportive of patient involvement.
Conclusions: Organizational structures and staff experience play a critical role in shaping patient participation. While interest is high, change requires addressing safety concerns, enhancing staff education, and defining roles clearly. Tailored strategies, considering unit-specific contexts, are essential for creating sustainable shared care models in hemodialysis.
Notes
References:
Albreiki, S., Alqaryuti, A., Alameri, T., Aljneibi, A., Simsekler, M. C. E., Anwar, S., & Lentine, K. L. (2023). A Systematic Literature Review of Safety Culture in Hemodialysis Settings. In Journal of Multidisciplinary Healthcare (Vol. 16). https://doi.org/10.2147/JMDH.S407409
Braithwaite, J., Churruca, K., Long, J. C., Ellis, L. A., & Herkes, J. (2018). When complexity science meets implementation science: A theoretical and empirical analysis of systems change. BMC Medicine, 16(1), 1–14. https://doi.org/10.1186/s12916-018-1057-z
Fotheringham, J., Barnes, T., Dunn, L., Lee, S., Ariss, S., Young, T., Walters, S. J., Laboi, P., Henwood, A., Gair, R., & Wilkie, M. (2021). A breakthrough series collaborative to increase patient participation with hemodialysis tasks: A stepped wedge cluster randomised controlled trial. PLoS ONE, 16(7 July). https://doi.org/10.1371/JOURNAL.PONE.0253966
Huang, M., Vincent Johnson, A., Pourafshar, N., Malhotra, R., Yang, J., Shah, M., Balogun, R., & Chopra, T. (2023). Pathways to improve nephrologist comfort in managing patients on in-center or home self-care dialysis. In Hemodialysis International (Vol. 27, Issue 3). https://doi.org/10.1111/hdi.13093
Moullin, J. C., Dickson, K. S., Stadnick, N. A., Rabin, B., & Aarons, G. A. (2019b). Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. In Implementation Science (Vol. 14, Issue 1, pp. 1–16). BioMed Central Ltd. https://doi.org/10.1186/s13012-018-0842-6
Sigma Membership
Omega Lambda
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Implementation Science, Hemodialysis, Patient Participation
Recommended Citation
Kurtz, Chava; Shadmi, Efrat; Skorecki, Karl; Antebi, Alon; Tsehovsky, Tatyana; and Spitzer, Sivan, "Patient and Provider Perspectives on Participation in Hemodialysis" (2025). International Nursing Research Congress (INRC). 223.
https://www.sigmarepository.org/inrc/2025/presentations_2025/223
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Patient and Provider Perspectives on Participation in Hemodialysis
Seattle, Washington, USA
Background: Patients undergoing hemodialysis often remain passive, with providers performing most treatment tasks. While patient participation can improve safety and care quality, its implementation is limited. This study explores patient and provider perspectives on participation, focusing on organizational factors influencing adoption. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we examined barriers and facilitators to shifting from a provider-dominant model to a shared-care approach.
Methods: A mixed-methods study followed a sequential design. First, a cross-sectional questionnaire was administered to 339 patients across two hospital- and two community-based units. It assessed patient interest and participation in care tasks, examining associations with unit and patient characteristics using logistic regression. Second, 36 semi-structured interviews with healthcare providers and administrators were conducted. These explored perceptions of patient participation using the EPIS framework’s inner context constructs. Qualitative data were analyzed thematically using Atlas.ti.
Results: Most patients expressed interest in participation, yet only 40% actively engaged. Factors influencing participation included unit type, venous access, and years on dialysis, with hospital-based units showing higher participation levels. The qualitative phase identified more barriers than facilitators, including safety concerns, rigid protocols, and the need for staff training. Community units faced stricter regulations, while hospital units provided more autonomy. Experienced nurses were more supportive of patient involvement.
Conclusions: Organizational structures and staff experience play a critical role in shaping patient participation. While interest is high, change requires addressing safety concerns, enhancing staff education, and defining roles clearly. Tailored strategies, considering unit-specific contexts, are essential for creating sustainable shared care models in hemodialysis.
Description
Patient participation in hemodialysis improves safety and quality but remains limited. A mixed-methods study explored patient and provider perspectives. A survey of 339 patients assessed interest and participation, identifying factors influencing engagement. Interviews with 36 providers examined barriers and facilitators using the EPIS framework. Findings highlight the need for tailored strategies to promote shared care, addressing safety, staff training, and unit-specific protocols.