Physician Knowledge and Attitudes Toward the Adoption of Peritoneal Dialysis in the Treatment of Patients With End-Stage Kidney Disease

Abstract

Introduction Hemodialysis (HD) is a significant contributor to Medicare spending. Peritoneal dialysis (PD) is a lower-cost dialysis modality with non-inferior clinical outcomes. Recent initiatives at the federal level have emphasized shifting dialysis from in-center to home modalities, namely, PD. Such policy has been slow to impact the distribution of HD and PD due to multiple barriers, including at the provider level. Previous research has characterized the role of patient knowledge gaps and preferences in the under-utilization of PD. We sought to understand physician knowledge and attitudes toward PD to elucidate provider-level barriers to PD adoption. Methods We conducted a 10-question survey assessing physician comfort level, perceived knowledge, and objective knowledge of HD and PD that was distributed among the internal medicine faculty at the University of Texas Southwestern Medical Center, Dallas, TX. The survey respondents included nephrologists and non-nephrologists. Demographic information of respondents was collected. Survey responses were summarized and stratified by medical specialty. All statistical tests used 0.05 as the statistical significance level. Results Among 391 survey recipients, there were 83 respondents (21.2%). The mean age of respondents was 43 and 54% were women. With regard to specialty, 88% of respondents were non-nephrologists and 12% were nephrologists. All respondents reported an increased level of comfort and experience caring for patients receiving HD compared to PD. Regardless of specialty, respondents had a high incorrect response rate with regard to contraindications to PD. While nephrologists reported high perceived knowledge regarding PD, objective assessments revealed knowledge gaps with regard to PD candidacy. Non-nephrologists reported lower perceived knowledge but scored better on objective knowledge assessments regarding medical contraindications to PD. Both specialty groups held misconceptions regarding psychosocial barriers to PD. Discussion This physician survey demonstrated overall decreased confidence in knowledge and experience in the care of patients receiving PD compared to HD. Knowledge assessments revealed discordance between perceived knowledge and objective knowledge with regard to contraindications to PD. These findings highlight ongoing misconceptions across medical specialties regarding the applicability of PD. These findings demonstrate the need for increased training on PD candidacy among nephrologists and non-nephrologists alike. These findings demonstrate the need for education and advocacy around PD for providers to effectively meet federal priorities advocating for shifting dialysis to the home. Conclusion This study demonstrates the impact of physician knowledge and attitudes toward PD in the under-utilization of PD as a dialysis modality. These findings demonstrate a need for increased provider education around PD candidacy and the benefits of shifting dialysis care to the home. Novel models of dissemination are needed to increase the adoption of PD and meet federal policy goals of shifting dialysis care to home-based modalities.

Keywords: general nephrology; hemodialysis; internal medicine division; knowledge attitude; peritoneal dialysis; peritoneal dialysis (pd); physician perception; survey.