Does Social Support Determine the Treatment Setting for Hemodialysis Patients?

The availability of an adequate system of social support has been suggested to be significant in determining whether an end-stage renal disease (ESRD) patient is dialyzed in a center or at home. To evaluate this hypothesis more completely, we conducted a study of social support among 257 home and center hemodialysis patients receiving maintenance therapy at four facilities in a midwestern, metropolitan area. A statistically significant difference, χ2(3) = 14.031, P = 0.0029, was observed in the percentage of patients with social support available to them across the four facilities. The distribution of patients between home and center hemodialysis at the facilities also differed significantly, χ2(3) = 14.919, P = 0.0019. An adequate social support system was present among 96.4% of the 55 home hemodialysis patients and 85.6% of the 202 center hemodialysis patients, a difference that was statistically significant, χ2(1) = 4.684, P = 0.0305. However, a more detailed analysis of these findings revealed that the presence of social support was not significant, χ2(1) = 1.080, P = 0.2995, in determining whether an ESRD patient was dialyzed at home or in a center after accounting for the facility differences. The facility differences remained significant in determining the setting of hemodialysis even after correcting for social support, χ2(3) = 10.740, P = 0.0132. We concluded, therefore, that the attitudes of clinical staff toward home and center hemodialysis and the willingness of staff to develop those resources that facilitate a specific treatment setting are the principal elements in the therapy selection process.

充足的社会支持系统的可获得性被认为在决定终末期肾病（ESRD）患者是在中心透析还是在家透析方面具有重要意义。为了更全面地评估这一假设，我们对中西部一个大都市地区的四个机构中接受维持性治疗的257名在家和在中心进行血液透析的患者的社会支持情况进行了研究。在四个机构中，有社会支持的患者百分比存在统计学上的显著差异，χ2(3)=14.031，P = 0.0029。这些机构中在家和在中心进行血液透析的患者分布也存在显著差异，χ2(3)=14.919，P = 0.0019。在55名在家血液透析患者中有96.4%以及在202名在中心血液透析患者中有85.6%拥有充足的社会支持系统，这一差异具有统计学意义，χ2(1)=4.684，P = 0.0305。然而，对这些发现进行更详细的分析表明，在考虑机构差异后，社会支持的存在对于决定ESRD患者是在家还是在中心透析并不显著，χ2(1)=1.080，P = 0.2995。即使在对社会支持进行校正后，机构差异在决定血液透析的环境方面仍然显著，χ2(3)=10.740，P = 0.0132。因此，我们得出结论，临床工作人员对在家和在中心血液透析的态度以及工作人员开发有利于特定治疗环境的资源的意愿是治疗选择过程中的主要因素。