How an ordeal becomes the norm: A qualitative exploration of experiences of selfcannulation in male home haemodialysis patients.

Objectives: Despite home haemodialysis (HHD) being associated with significant health and psychosocial benefits, it remains an under-utilised dialysis modality for people with chronic kidney disease. Self-cannulation, where patients insert their own needles for dialysis, is a key component of HHD. Recent research suggests that the prospect of selfcannulation is a barrier for patients, but there is little research which examines why this is the case. The aim of this study was to explore male HHD patients' experiences and attitudes towards self-cannulation.

Design: Qualitative methods were adopted to gather in-depth views from experienced HHD patients from a UK renal centre.

Methods: Semi-structured interviews were conducted with 8 male HHD patients (HHD duration: 12-55 months). During the interview, the researcher elicited participants' lived experience of self-cannulation. Topics included the decision to self-cannulate and the impact of self-cannulation on the patient. The data collected were analysed using interpretative phenomenological analysis.

Results: The findings from this study elucidate the process of how self-cannulation changed from an ordeal to the norm in these participants' lives. The central theme from these interviews is that "becoming a person who self-cannulates is a process". Three super-ordinate themes were discussed that relate to this central theme: "gaining control", "building confidence", and "becoming the norm".

Conclusions: The findings from this study suggest that some patients' initial fears of selfcannulation can be overcome. These findings offer healthcare professionals and patients alike a greater understanding of how patients who self-cannulate conceptualise it and its role in their mental and physical health.