Kidney Medicine (Oct 2024)
Dementia Care Among United States Dialysis Providers: A Mixed Methods Study Evaluating Clinician Comfort and Knowledge
Abstract
Rationale & Objective: Given the high burden of dementia in dialysis patients, the dialysis workforce needs to be prepared to provide high-quality, person-centered dementia care. We explored comfort with and knowledge of dementia among US dialysis care providers. Study Design: Web-based survey. Setting & Participants: Emails were sent to National Kidney Foundation and National Association of Nephrology Technicians/Technologists membership listservs (September 26, 2022-October 22, 2022). In total, 1,121 respondents had complete data for analysis (57%, 35-49 years; 62% female; 62%/22% White/African American) including 81 physicians, 61 advanced practice providers, 230 nurse managers, 260 nurses, 202 social workers, 195 dietitians, and 86 dialysis patient care technicians. Exposures: Provider role, age, tenure, self-reported gender, previous dementia training, and awareness of dementia guidance. Outcomes: Dementia Knowledge (assessed using Dementia Knowledge Assessment Scale [DKAS; score range, 0-25]). Analytic Approach: Characteristics of respondents, comfort with dementia care, and dementia knowledge were summarized and tabulated overall and by role. Robust regression was used to obtain coefficients confidence intervals for the associations between characteristics and DKAS scores, adjusting for role and tenure. Free-text responses to an open-ended question about treating patients with dementia or cognitive impairment were analyzed using thematic analysis. Results: Dementia knowledge among US dialysis providers may be limited (overall DKAS score = 17; range, 13-21 across roles), despite most reporting knowing when patients had dementia (97%) and receiving training in dementia care (62%). Further, training may be inadequate: those who reported receiving dementia training had lower DKAS scores than those who reported not receiving training (β, –3.9; 95% CI, –4.4 to –3.4). Thematic analysis of open-ended responses suggested that the impact of dementia on dialysis care and management and treatment beyond dialysis care are challenging for providers. Limitations: Data were self-reported and limited information was gathered about quality, content, and timing of dementia training received. Conclusion: Many US dialysis care providers had suboptimal dementia knowledge, despite reporting being comfortable with providing dementia care and reporting they received prior training. Qualitative findings indicate complexity among providers regarding comfort with and knowledge of treating patients with cognitive impairment. Targeted training for the dialysis workforce in dementia knowledge and best practices for person-centered dementia care is warranted. Plain-Language Summary: There is a high burden of mild cognitive impairment and dementia in the US in-center hemodialysis setting. Although the prevalence of dementia is increasing, little is known about the readiness for the interdisciplinary team to provide person-centered, dementia-friendly patient care. Examining data from a US web-based survey, we found that providers felt confident in knowing when a patient had cognitive impairment, but less than two-thirds reported receiving training about dementia. Further, those who received training about dementia or had awareness of dementia guidelines had lower scores for dementia knowledge. This information can be used to develop training and guidance for interdisciplinary team to reduce staff burden and improve quality of care for patients living with cognitive impairment.
