Dr Nicole Scholes-Robertson1,2, Dr Sachin Kodgire3, Dr Cherian Sajiv3,4, Mr Dale Coghlan4, Dr Karine Manera1,2, Mr Luca Torriso1,2, Professor Allison Jaure1,2
1The University Of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, Sydney, Australia, 3Nephrology Department, Alice Springs Hospital, Alice Springs, NT Australia, Alice Springs, Australia, 4Faculty of Medicine and Public Health, Flinders University, Adelaide, Australia, Adelaide, Australia
Biography:
Dr Nicki Scholes-Robertson PhD is a rural and remote equity researcher with lived experience of PD and kidney transplantation. She is a Research fellow at teh University of Sydney.
Background:
Central Australia has high rates of kidney failure, particularly in Aboriginal and Torres Strait Islander people from remote and very remote communities but has the lowest rates of uptake of peritoneal dialysis (PD) in Australia.
Aim:
To describe health professionals’ perspectives on access to and uptake of peritoneal dialysis in Central Australia.
Methods:
Semi-structured interviews were conducted with clinicians involved in the care of patients with kidney failure in Central Australia. All transcripts were thematically analysed. We followed the Consolidated Criteria for Reporting Qualitative Research.
Results:
A total of 17 clinicians including nephrologists (n=6), nurses (n=8), general practitioners (n=3) participated. We identified six themes: extensive housing obstacles (with subthemes of overwhelmed by overcrowding, limited availability of secure storage, uncertainty of accommodation and without sustainable electricity), prominence of haemodialysis (familiarity with the “machine”, benefits of incentre attendance, disempowered by dependence, family and caregiver preference for the known), concern about peritonitis (perpetuated storytelling of bad tummy dialysis, concern for patient selection, geographic remoteness from specialist services, high infection burden in population), instability of remote workforce (limited primary health knowledge of PD, impermanence of staff), compounding complexities of comorbidities and dearth of culturally and linguistically appropriate educational tools.
Conclusions:
Clinicians believe that the low uptake of PD in Central Australia is influenced by structural barriers such as overcrowded and insecure housing, persistent negative perceptions of PD related to infection risk, and the relative safety and familiarity of haemodialysis. Addressing housing inadequacies and improving culturally appropriate education may support greater acceptance and utilisation of PD in this setting.
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