Abstract
This report on the difficulties of training patients for home dialysis is based on two years of experience with eight patients. In that period only one patient has gone on home dialysis; another is on his way, and the other six patients are still in various stages of resistance to home dialysis. Clinical psychiatric observations carried out during these two years helped to identify five factors that influence the patient's and the family's attitudes to home dialysis. In the present report two of these factors were briefly described: the financial situation and what we called the “set-up” as well as the “normal” apprehension and fear of dialysis. More attention was given to the other three factors: the attitude of the medical team, which in our unit was strongly anti-home dialysis and was attributed to overprotectiveness, possessiveness and injury to the professional image; the personality of the patient as it influenced his attitude to home dialysis and especially the patient's dependency needs; and the patient's family emphasizing the family's aggression and methods of handling it. Towards the end of the report some suggestions for avoiding the extreme resistance to home dialysis were brought up.
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