Purpose of program: Canada's growing prevalence of people with kidney failure receiving kidney replacement therapy has necessitated the expansion of dialysis programs. Although facility-based hemodialysis is the predominant dialysis modality in Canada, it is substantially costlier than home dialysis (peritoneal or home hemodialysis). Initiatives to increase the uptake of home dialysis typically consist of didactic and experiential education. We describe a novel local initiative, Home Sweet Home (HSH), where individuals with lived experience of home dialysis and kidney health professionals share their experience and knowledge with participants in a clinic setting that has been set up to represent a metaphorical home. The aim of this report is to describe our HSH program and to evaluate its acceptability and reach for future scale and spread. We also explored home dialysis uptake among program participants.Sources of information: We collected feedback from attendees following each HSH event with anonymized surveys. We obtained clinical and demographic data and modality at follow-up from 2 linked databases, the Canadian Organ Replacement Register (CORR) and a regional clinical database, the Nephrology Information System (NIS).Methods: Reach was evaluated according to modality (i.e., the proportion of participants who were non-dialysis dependent vs the proportion receiving facility-based maintenance hemodialysis) and the proportion living remotely (defined as greater than 200 km from the event). We examined acceptability as the proportion who were interested in a home therapy (either peritoneal dialysis, home hemodialysis, or both) after attending the event. Demographic data and survey data were summarized with counts and percentages. Free text from surveys was collated and summarized. Participants were followed from the time of program attendance until June 21, 2022 or death.Key findings: A total of 291 participants attended HSH between 2015 and 2019. At the time of program attendance, 70% of participants had chronic kidney disease (CKD) not requiring dialysis (CKD G4-5ND) and 30% had CKD G5D on facility-based maintenance hemodialysis. Participants were primarily urban dwelling (ie, in Edmonton). After the event, 92% of participants indicated they were interested in a home dialysis modality. From the survey free text, participants commonly expressed that they valued the "first-hand information" and a "real life perspective" from HSH facilitators and the simulation helped to ease anxiety about home dialysis. Participants expressed a desire for longer HSH events with more opportunities to ask questions. At a median follow-up of 858 days (interquartile range = 353-1347), 18% of the cohort remained dialysis independent and 25% died. Of the remaining 167 participants, N = 41 (25%) were receiving a home dialysis modality (either peritoneal dialysis or home hemodialysis), N = 40 (24%) received a kidney transplant, and N = 86 (51%) were dialyzing with facility-based hemodialysis.Limitations: A more in-depth understanding of how the HSH program influenced decision-making for home dialysis could be attained from interviews and focus groups. No causal inferences can be made regarding the uptake of home therapies and HSH attendance. We did not have data on who received a home therapy prior to the last recorded modality at follow-up, which likely underestimated the use of home therapies.Implications: The HSH program was highly acceptable with 92% of participants reporting they were interested in a home modality. The reach of HSH could be improved by recruiting more individuals from facility-based hemodialysis and rural and remote locations. Objectif du programme: Au Canada, la pr & eacute;valence croissante des personnes atteintes d'insuffisance r & eacute;nale recevant une th & eacute;rapie de suppl & eacute;ance r & eacute;nale a n & eacute;cessit & eacute; l'expansion des programmes de dialyse. L'h & eacute;modialyse en centre demeure la modalit & eacute; pr & eacute;dominante au Canada, mais elle est beaucoup plus co & ucirc;teuse que la dialyse & agrave; domicile (dialyse p & eacute;riton & eacute;ale ou h & eacute;modialyse & agrave; domicile). Les initiatives visant & agrave; accro & icirc;tre l'adoption de la dialyse & agrave; domicile consistent g & eacute;n & eacute;ralement en de l'& eacute;ducation didactique et exp & eacute;rientielle. Nous d & eacute;crivons une nouvelle initiative locale, Home Sweet Home (HSH), o & ugrave; des personnes ayant un v & eacute;cu exp & eacute;rientiel de la dialyse & agrave; domicile et des professionnels de la sant & eacute; r & eacute;nale partagent leurs exp & eacute;riences et leurs connaissances avec des participants dans un cadre clinique am & eacute;nag & eacute; de fa & ccedil;on & agrave; repr & eacute;senter un foyer. Cet article d & eacute;crit notre programme HSH et l'& eacute;valuation de son acceptabilit & eacute; et de sa port & eacute;e en vue de sa propagation et de son & eacute;ventuel d & eacute;ploiement & agrave; grande & eacute;chelle. Nous avons & eacute;galement explor & eacute; l'adoption de la dialyse & agrave; domicile chez les participants au programme.Sources de l'information: Les commentaires des participants apr & egrave;s chaque & eacute;v & eacute;nement HSH ont & eacute;t & eacute; recueillis par l'entremise de sondages anonymes. Les donn & eacute;es cliniques et d & eacute;mographiques, ainsi que les donn & eacute;es sur la modalit & eacute; lors du suivi ont & eacute;t & eacute; obtenues & agrave; partir de deux bases de donn & eacute;es coupl & eacute;es, soit le Registre canadien des insuffisances et des transplantations d'organes (RCITO) et une base de donn & eacute;es cliniques r & eacute;gionale, le Nephrology Information System (NIS).M & eacute;thodologie: La port & eacute;e du programme a & eacute;t & eacute; & eacute;valu & eacute;e selon la modalit & eacute; (c.-& agrave;-d. la proportion de participants non d & eacute;pendants de la dialyse par rapport & agrave; la proportion de participants recevant une h & eacute;modialyse d'entretien en centre) et la proportion de participants r & eacute;sidant en r & eacute;gion & eacute;loign & eacute;e (d & eacute;finie comme r & eacute;sidant & agrave; plus de 200 km de l'& eacute;v & eacute;nement). L'acceptabilit & eacute; a & eacute;t & eacute; d & eacute;termin & eacute;e par la proportion de personnes int & eacute;ress & eacute;es par une th & eacute;rapie & agrave; domicile (dialyse p & eacute;riton & eacute;ale, h & eacute;modialyse & agrave; domicile ou les deux) apr & egrave;s avoir assist & eacute; & agrave; l'& eacute;v & eacute;nement. Les donn & eacute;es d & eacute;mographiques et les donn & eacute;es tir & eacute;es des sondages ont & eacute;t & eacute; r & eacute;sum & eacute;es en chiffres et pourcentages. Les r & eacute;ponses sous format de texte libre dans les sondages ont & eacute;t & eacute; rassembl & eacute;es et r & eacute;sum & eacute;es. Les participants ont & eacute;t & eacute; suivis du moment de leur Au moment de leur participation au programme, 70 % des personnes souffraient d'insuffisance r & eacute;nale chronique (IRC) ne n & eacute;cessitant pas de dialyse (IRC G4-5ND), alors que 30 % & eacute;taient atteint d'IRC G5D et recevaient l'h & eacute;modialyse d'entretien en centre. Les participants r & eacute;sidaient principalement en milieu urbain (Edmonton). Apr & egrave;s avoir assist & eacute; & agrave; un & eacute;v & eacute;nement, 92 % des participants ont indiqu & eacute; & ecirc;tre int & eacute;ress & eacute;s par la dialyse & agrave; domicile. Dans les questions & agrave; d & eacute;veloppement du sondage, plusieurs participants ont mentionn & eacute; avoir appr & eacute;ci & eacute; les << informations de premi & egrave;re main >> et la << perspective de personnes avec un v & eacute;cu exp & eacute;rientiel >> donn & eacute;es par les animateurs de l'& eacute;v & eacute;nement HSH, et que la simulation les avait aid & eacute;s & agrave; apaiser leur anxi & eacute;t & eacute; & agrave; l'& eacute;gard de la dialyse & agrave; domicile. Les participants ont & eacute;galement exprim & eacute; le souhait que des & eacute;v & eacute;nements HSH prolong & eacute;s soient organis & eacute;s et qu'ils comportent davantage d'occasions de poser des questions. Apr & egrave;s un suivi m & eacute;dian de 858 jours (intervalle interquartile: 353 & agrave; 1 347), 18 % des membres de la cohorte & eacute;taient toujours non d & eacute;pendants de la dialyse et 25 % & eacute;taient d & eacute;c & eacute;d & eacute;s. Des 167 participants restants, 41 (25 %) recevaient la dialyse & agrave; domicile (dialyse p & eacute;riton & eacute;ale ou h & eacute;modialyse & agrave; domicile), 40 (24 %) avaient re & ccedil;u une greffe de rein et 86 (51 %) & eacute;taient sous h & eacute;modialyse en centre.Limites: Des entrevues individuelles et des groupes de discussion pourraient permettre de mieux comprendre la fa & ccedil;on dont le programme HSH influence la prise de d & eacute;cision pour la dialyse & agrave; domicile. Aucune inf & eacute;rence causale ne peut & ecirc;tre & eacute;tablie entre l'adoption de th & eacute;rapies & agrave; domicile et la fr & eacute;quentation du programme HSH. Les donn & eacute;es sur les personnes qui avaient d & eacute;j & agrave; re & ccedil;u une th & eacute;rapie & agrave; domicile avant la derni & egrave;re modalit & eacute; enregistr & eacute;e lors du suivi n'& eacute;taient pas disponibles, ce qui a probablement sous-estim & eacute; l'utilisation des th & eacute;rapies & agrave; domicile.Conclusion: L'acceptabilit & eacute; du programme HSH s'est av & eacute;r & eacute;e excellente puisque 92 % des participants ont d & eacute;clar & eacute; & ecirc;tre int & eacute;ress & eacute;s par une modalit & eacute; de dialyse & agrave; domicile. La port & eacute;e du programme pourrait & ecirc;tre am & eacute;lior & eacute;e en recrutant plus de personnes sous h & eacute;modialyse en centre et r & eacute;sidant en r & eacute;gions rurales et & eacute;loign & eacute;es.
