Medical and nursing interventions influence a caregiver’s willingness to continue home hemodialysis: a multicenter cross-sectional survey

Background: In Japan, home hemodialysis (HHD) has several benefits, including a favorable prognosis, enhanced quality of life (QOL) of patients, and cost-effectiveness. However, the caregiver’s burden in assisting patients on HHD is significant, which influences their decision to continue HHD. This study focused on the relationship between medical and nursing interventions, caregiver resolve to continue HHD, and caregiver quality of life, aiming to create support strategies for caregivers. Methods: A multicenter cross-sectional survey was conducted on caregivers of patients on HHD from 150 HHD facilities in Japan. The caregiver’s intent to continue HHD was assessed using a four-tier response scale that evaluated aspects such as caregiver–healthcare provider meetings, caregiver breaks, treatment discussions, difficulty in HHD initiation, and post-initiation medical support. Caregiver QOL was evaluated using the Short-form Health Survey, eight domains (SF-8). Statistical analysis involved χ-squared tests, independent t-tests, and propensity score matching. Results: The study achieved a caregiver participation rate of 55.6%. Results indicated that caregivers who were inclined to continue HHD were significantly more likely to receive respite outpatient dialysis and had a better understanding of HHD mechanics as explained by healthcare professionals; however, propensity score matching revealed limited generalizability. There was no significant difference in the SF-8 scores before and after propensity score matching among the groups. Conclusions: This study highlights that there are a small number of caregivers who have little motivation to continue HHD and emphasizes the crucial role of support from healthcare professionals. Comprehensive support, including respite dialysis and detailed HHD information, may affect HHD sustainability.