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

Abstract 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 and Participants: Thirteen health care providers, 13 patients, and 4 care partners with at least 3 months experience with PD were recruited from the US and UK through postings in PD clinics, websites, and social media. Method ology: 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 Four 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 like 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.