Abstract
Latinx individuals with end-stage kidney disease (ESKD) constitute 19% of US patients receiving in-center scheduled hemodialysis. Compared with non-Latinx White patients, Latinx individuals often face poor economic, environmental, and living circumstances. The challenges for health care professionals engendered by these circumstances when Latinx individuals present with ESKD and possible solutions have not been well described. To examine the perceptions of interdisciplinary health care professionals who work in dialysis centers in urban settings with large racial and ethnic minority populations about how social challenges affect the care of Latinx patients with ESKD. This qualitative study administered semistructured interviews of interdisciplinary health care professionals at 4 urban dialysis centers in Denver, Colorado, from April 1 to June 30, 2019. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Themes and subthemes of barriers to care. Thirty interdisciplinary dialysis center health care professionals (23 [77%] female; mean [SD] age, 42.0 [11.6] years) participated. Four themes were identified. The first 3 themes and their respective subthemes (in parentheses) describe challenges to kidney care: compromised quality of care attributable to communication and cultural barriers (language interpretation by telephone, in-person language interpretation, burden of ad hoc interpretation, low-quality health care, lack of language- and culturally concordant materials, and health literacy levels), difficulty with health care access (unreliable transportation, economic instability, and loss of insurance benefits), and concerns about patient psychosocial well-being (social isolation, hopelessness, stigma of illness, and balancing personal social challenges). The fourth theme describes solutions to improve care (culturally responsive care, patient empowerment and activation, supporting primary caregivers, and peer support with navigation of the health care system). This study's findings suggest that dialysis center policies are needed that require high-quality language interpretation and the availability of culturally concordant educational materials. Community-based interventions that improve patient activation and provide peer support as well as culturally responsive care may improve the care of Latinx patients with ESKD receiving in-center scheduled hemodialysis.
Highlights
The Latinx community constitutes 19% of individuals with end-stage kidney disease (ESKD) receiving in-center scheduled hemodialysis thrice weekly in the US.[1]
Community-based interventions that improve patient activation and provide peer support as well as culturally responsive care may improve the care of Latinx patients with ESKD receiving in-center scheduled hemodialysis
Meaning The results of this study suggest that policies that require highquality language interpretation and the availability of culturally concordant educational materials are needed in the dialysis setting
Summary
The Latinx community constitutes 19% of individuals with end-stage kidney disease (ESKD) receiving in-center scheduled hemodialysis thrice weekly in the US.[1] Social challenges (ie, economic, environmental, and living conditions) are potential determinants of health that are associated with poor outcomes among members of racial and ethnic minority groups with kidney disease.[2,3,4,5,6,7,8,9,10,11,12,13,14] Latinx (ie, Hispanic, preferred non–gender-based term for Latino/Latina) individuals often face additional challenges, such as language barriers, lack of culturally concordant educational materials, and discrimination.[15,16,17,18,19,20,21] Among Latinx individuals with chronic kidney disease, an estimated 66% report limited English proficiency (LEP), but little is known about the availability of language interpreters.[22] The Latinx ESKD community is heterogeneous, representing a wide variety of national origins and cultural groups; little is known about the availability of culturally concordant educational materials.[22,23,24] Regarding immigration status, many Latinx US citizens with ESKD live in mixed immigration-status families, and many report fear of discrimination.[19,20,25,26]
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