Staff perceptions of patient self-care in hemodialysis treatment tasks: a qualitative exploration using the Exploration Preparation Implementation Sustainment Framework

Background: People with end stage kidney disease receiving haemodialysis typically receive treatment in-center, where tasks are mainly performed by healthcare providers with limited patient participation. Incorporating patient participation in performing at least some of the haemodialysis care tasks can enhance safety, efficiency, and quality, yet is rarely performed. Implementing change requires a comprehensive strategy, addressing both patient and provider organizational factors. Using the Exploration Preparation Implementation Sustainment (EPIS) framework, we examined the factors that may affect a change in the delivery of haemodialysis care and identified potential barriers and facilitators to shifting care provision from a provider-dominant model to a more participatory shared-care approach. Methods: Individual semi-structured interviews with managers and staff were conducted to understand their perceptions and insights of patient participation in treatment care tasks in haemodialysis. The interview guide focused on inner context and was built based on the EPIS framework of inner context constructs. Data was analysed with the aid of Atlas.ti using a combination of inductive and deductive approaches to map themes and sub-themes into the EPIS constructs. Results: A total of 36 interviews were conducted in two hospital- and two community-based units with nurses, physicians and managerial personnel. Results are presented according to EPIS constructs, highlighting more barriers than facilitators for implementing patient-shared care. As safety, quality of care, and patient satisfaction were found to be essential aspects of care in all units, implementing increased patient participation requires safety measures, staff education on new nursing approaches, and clear responsibility definitions. Unit settings differed in regulations and protocols. Conclusions: Using EPIS, we identified drivers of implementation success for increasing patient participation in in-center haemodialysis care. These findings are key to inform the design of impactful, scalable, and sustainable programs. Different haemodialysis settings, with varying organizational structures and climate, prioritize patient participation differently. While all units aim for high-quality, efficient, and safe care, the differences in organizational structure and individual adopter characteristics would require significantly different approaches during planning and implementation.