Renal staffs' understanding of patients' experiences of transition from peritoneal dialysis to in-centre haemodialysis and their views on service improvement: a multi-site qualitative study in England and Australia

Research output: Contribution to journalArticlepeer-review


  • David W. Johnson
  • Mark Lambie
  • Els Holvoet
  • Simon J. Davies

External organisations

  • Keele University
  • Ghent University Hospital
  • University of Queensland


INTRODUCTION: Many studies have explored patients' experiences of dialysis and other treatments for kidney failure. This is the first qualitative multi-site international study of how staff perceive the process of a patient's transition from peritoneal dialysis to in-centre haemodialysis. Current literature suggests that transitions are poorly coordinated and may result in increased patient morbidity and mortality. This study aimed to understand staff perspectives of transition and to identify areas where clinical practice could be improved.

METHODS: Sixty-one participants (24 UK and 37 Australia), representing a cross-section of kidney care staff, took part in seven focus groups and sixteen interviews. Data were analysed inductively and findings were synthesised across the two countries.

RESULTS: For staff, good clinical practice included: effective communication with patients, well planned care pathways and continuity of care. However, staff felt that how they communicated with patients about the treatment journey could be improved. Staff worried they inadvertently made patients fear haemodialysis when trying to explain to them why going onto peritoneal dialysis first is a good option. Despite staff efforts to make transitions smooth, good continuity of care between modalities was only reported in some of the Australian hospitals where, unlike the UK, patients kept the same consultant. Timely access to an appropriate service, such as a psychologist or social worker, was not always available when staff felt it would be beneficial for the patient. Staff were aware of a disparity in access to kidney care and other healthcare professional services between some patient groups, especially those living in remote areas. This was often put down to the lack of funding and capacity within each hospital.

CONCLUSIONS: This research found that continuity of care between modalities was valued by staff but did not always happen. It also highlighted a number of areas for consideration when developing ways to improve care and provide appropriate support to patients as they transition from peritoneal dialysis to in-centre haemodialysis.

Bibliographic note

Funding information: This work was undertaken as part of the INTEGRATED consortium, funded by the Baxter Global Grant Program awarded to DWJ, ML and SJD (no associated grant number). SLD and JEJ were supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West Midlands (NIHR CLAHRC WM), now recommissioned as NIHR Applied Research Collaboration West Midlands (NIHR ARC WM) ( The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. DWJ is supported by an Australian National Health and Medical Research Council Leadership Investigator Grant ( The study was sponsored by University of Birmingham. The funders and sponsors had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


Original languageEnglish
Article numbere0254931
JournalPLoS ONE
Issue number7
Publication statusPublished - 19 Jul 2021