Table 1.

Home HD barriers and potential solutions

Barriers	Potential solutions
Lack of exposure, visibility, and education regarding home HD	Units adopt formal predialysis education with nonbias information regarding all treatment options
Preconception that home HD is “too difficult and complex”	Training for clinical staff to increase confidence in home HD Utilization and further development of simpler home HD training machines
Lack of patient confidence to perform home HD	Peer support from established home HD patients
Fears of vulnerability and isolation from medical support	Strong clinical recommendation for home HD
Unexpected problems at early stage of home HD	Increased support when patient transitioning home
Fear of self-cannulation	Technological support for patient at home Community house models of care
Caregiver burden	Encouraging home HD independence with enhanced support Paid models of support – family members or support staff Inclusion of family members in education and training
Increased cost of home HD to patient	Transparent information regarding expected costs Reimbursement for out-of-pocket costs Community houses
Increased travel expenses	Units provide flexible and individualized training programs (after hours/5 day week/training in home)
Extended training duration	Exploration of return and training work policy
Housing problems (storage and water quality)	Developments in technology and home HD machines Independent community houses
Socioeconomic disadvantage	Reimbursement for out-of-pocket, transport, and setup costs Independent community houses Increased support and peer education for minority and indigenous groups Government policy and incentive programs

Abbreviation: HD, hemodialysis.