and study coordinator from each of the 8 sites of the FHN Nocturnal Trial (nocturnal HHD compared to conventional HD) were asked to complete a survey focused on barriers to HHD. 80 The most common perceived barriers to patients electing to choose HHD (reported by > 66% of respondents) were lack of motivation, patients comfortable in-center, fear of self-cannulation, fear of needles falling out or catheter disconnecting, fear of inability to sleep during nocturnal dialysis, high level of comorbid disease, lack of family/partner support, fear of machine, and fear of inability to learn procedures. Home renovation costs were subsidized by outside sources so were not perceived as a barrier. The most common perceived incentives (reported by > 66% of respondents) were flexible scheduling, flexible prescription, less travel to dialysis unit, more liberal diet (with nocturnal HHD), partner encouragement, influence of other HHD patients, more privacy, putative improvement in well-being, and dissatisfaction with current therapy. A survey of nurses from one health network in Canada included both home dialysis nurses (HHD, PD, and pre-dialysis clinic) and HD nurses.88 The home dialysis nurses thought HHD was strongly preferred for working patients or students. The in-center HD nurses thought HD was strongly preferred for patients with poor socioeconomic status, multiple chronic illnesses, and no caregiver or social support. Home dialysis nurses thought that HHD benefited patient quality of life and survival and was lower in cost for patients and the healthcare system. HD nurses thought that HD was preferred for lower risk of catastrophic events. Physicians were rated as having the most influence on patients’ choice of modality by 87% of the home dialysis nurses and 57% of the HD nurses. The Australian study of information about treatment options (cited above in the PD section) also provided information about HHD.81 Reasons for not providing information about HHD included medical/surgical contraindications, unsuitable living conditions, low literacy, no social/community support at home, psycho-social contraindications, and patient/family refusal. HHD patients were more likely known to the nephrologist for 3 months or longer and more likely to have a caregiver with them at information sessions. 45 Home-based versus In-center Dialysis Evidence-based Synthesis Program Patient Factors (Table 5 and Appendix C, Table 5) Peritoneal Dialysis Selection An RCT (n=70) from Canada compared outcomes following an educational intervention (written manuals, videos, small group session) or standard care.89,90 The goal of the intervention was to increase patient selection of self-care dialysis defined as PD, HHD, and self-care HD. At baseline, there was no significant difference between the groups in the percentage of patients intending to start self-care dialysis. At completion of the study, the difference was significant (82% of the intervention group, 50% of the control group; P = .015).89 Among those who were uncertain at baseline or who planned to start with HD, 64% of the intervention group and 17% of the control group (P = .01) planned to start self-care dialysis at the end of the intervention period. Participation in the intervention group was associated with increased odds of choosing self-care (OR 10.2 [95% CI 2.0, 50.3], P = .004).89 Of the 12 patients who started dialysis during a mean follow-up of 339 days, 2 patients died and 2 of 3 intervention group (4 of 7 control group) patients started with self-care dialysis. 89 Additional analyses identified patient-reported perceived advantages of self-care dialysis. 90 The advantages were categorized as “freedom,” “lifestyle,” and “control.” Freedom and lifestyle were significantly associated with intended choice of selfcare dialysis (OR 9.1 [95% CI 2.0, 41.3], P = .004 for freedom; OR 7.0 [95% CI 1.6, 29.7], P = .008 for lifestyle). The perception of no advantage of self-care dialysis was associated with reduced odds of selecting that modality (OR 0.06 [95% CI 0.01, 0.24], P < .001). In the intervention group (but not the control group) there was an increase in the percentage identifying freedom and control as advantages and a decrease in the percentage reporting no advantage.90 An earlier report of a cross-sectional survey of patients attending a progressive renal insufficiency clinic (active promotion of self-care dialysis) categorized barriers to self-care as knowledge, attitudes, and skills. 91 For knowledge, lack of explanation of self-care and lack of understanding were the most frequently identified barriers. In the attitudes category, fear of social isolation, concerns about being unsupervised, lack of self-efficacy in performing self-care, and fear of substandard care were identified. Needle phobia, lack of space at home, and visual impairment were cited. A study from Austria compared patients who voluntarily chose to attend a 2-day pre-dialysis education program to a standard care group. 92 Of 70 patients from the education group who progressed to dialysis during the study period, 32 (46%) chose HD and 38 (54%) chose PD. Of 157 standard care patients who progressed to dialysis, 113 (72%) chose HD and 44 (28%) chose PD. The odds ratio for choosing PD following participation in the education program was 3.35 (95% CI 1.82, 6.14). One US study compared a treatment options