Dementia Care Among United States Dialysis Providers: A Mixed Methods Study Evaluating Clinician Comfort and Knowledge

Abstract

Rationale & ObjectiveGiven 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 U.S. dialysis care providers. Study DesignWeb-based survey Setting & ParticipantsEmails were sent to National Kidney Foundation and National Association of Nephrology Technicians/Technologists membership listservs (9/26/22-10/22/22). 1121 respondents had complete data for analysis (57% 35-49 years; 62% female; 62%/22% white/Black) [including 81 physicians, 61 advanced practice providers, 230 nurse managers, 260 nurses, 202 social workers, 195 dietitians, and 86 dialysis patient care technicians]. ExposuresProvider role, age, tenure, gender, previous dementia training, awareness of dementia guidance. OutcomesDementia Knowledge (assessed using Dementia Knowledge Assessment Scale (DKAS; score range, 0-25)]. Analytic ApproachCharacteristics 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. ResultsDementia knowledge among U.S. 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,-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. LimitationsData were self-reported and limited information was gathered about quality, content, and timing of dementia training received. ConclusionMany U.S. 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.