DIALYSIS ACCESS INTENTIONS: EXAMINING PSYCHOSOCIAL RISK FACTORS IN PRE-DIALYSIS PATIENTS

Abstract

There is limited quantitative work around psychosocial factors contributing to suboptimal dialysis initiation among chronic kidney disease (CKD) patients. This study aimed to (a) construct a Beliefs about Dialysis Access Questionnaire and (b) identify factors explaining patients' active intentions towards dialysis access creation. We evaluated 182 pre-dialysis CKD patients and 122 family members using self-report measures on illness perceptions, anxiety and depression symptomatology, health-related quality of life, health literacy, and decisional conflict. Active intentions towards access creation was measured as a dichotomous variable. Perceptions of dialysis and access creation were evaluated using items developed for this study following prior qualitative work. Exploratory factor analysis on these items revealed 5 domains: Access Concerns, Shared Decision-Making, Need for Dialysis, Worry about Cost, and Value of Access. High rates of delay intentions (51.6%) were found among patients despite early referral and education. Binary logistic regression analysis revealed higher odds of active intentions to proceed with access among patients with greater Value of Access, lower Access Concerns, poorer general health, and greater patient satisfaction. Findings have implications for identifying patients at greater risk of suboptimal dialysis initiation and highlight the need for understanding and addressing concerns and benefits about access creation.