One issue out here seems to be the retention of patients after they start home modalities.
What are the processes you go through in first of all making sure the patient and their families are the right fit for the treatment, and as with all things…as process goes along…things come up and patients or family get discouraged, overwhelmed. How do you address those issues - I think if they can be helped thru the peaks and valleys of the learning process…they will ultimately “get there.” Thanks for your thoughts on this.

This is a major issue when starting home dialysis. First of all, you do not have to be highly educated to start home dialysis. Many on home dialysis do not even graduate high school. All it takes is dedication.
and a will to be in control and suceed before you choose to go on home dialysis. The nephrologist and everyone else that will be involved need to lay everything on the table. Not just the good or bad, but everything. They need to know what is in store for them. Let them know they have options. Perhaps even let them talk to other patiens already performing home dialysis. Show them the equipment involved.
From my experience, many get overwelmed because somehing occurs that has not been discussed and then the patient/caregiver gets angry and discouraed.
The clinics should provide the patients with as much information as possible on all modalities and then discuss them with their nephrlogist and make a choice together.
Many centers do not give a choice. You are stuck with whatever equipment thay have their contract with and usually its only one company. Instead of trying t compete, lets give the patients choice. Cut the red tape and let everyone decide together instead of how much money th center is going to make off of you.
Finally, once the decision has been made and you are already at home with training being over, you cant just forget about the home patient. The center/nephrologist should keep the patient up to date on new technologies/procedures current and future. You cant just train them and place the patient aside. The patient and center must work together and stay informed. With everyone working together with the sharing of information, I feel patients will be more interested and not get discouraged.