Reasons renal patients give for deciding not to dialyze: a prospective qualitative interview study.

Noble, Helen and Meyer, Julienne and Bridges, Jackie and Kelly, Daniel and Johnson, Barbara (2009) Reasons renal patients give for deciding not to dialyze: a prospective qualitative interview study. Dialysis & Transplantation, 38 (3). pp. 82-89. ISSN 0090-2934

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BACKGROUND As the population ages, sicker patients often with multiple comorbidities are presenting in renal clinics. Some are deciding not to embark on dialysis. The objective of this study was to gain an understanding of the decision that some patients make not to embark on dialysis. METHODS Naturally occurring qualitative interviews were conducted with 30 patients and 17 caregivers managed within a Renal Supportive Care Service in an acute NHS Trust in London. RESULTS Several patients believed they had made an informed and autonomous decision, either on or against the advice of their doctor (n 5 17); some felt that they had no option but to refuse dialysis treatment, as it would not have been of benefit and might ultimately cause their death (n 5 7); some stated they had decided to opt for medication rather than dialysis 3 times a week and seemed to believe that either option would lead to the same outcome (n 5 2), and some felt there had been no decision to be made (n 5 4). CONCLUSIONS Prior to this study, little was known about those who decide not to embark on dialysis and how they make this decision. It cannot be presumed that decisions made by patients are fully understood and free from inappropriate professional or family influence, and the decision needs to be regularly revisited to check patients' and caregivers' understanding and to allow for reversal of the decision if fitting. There is a need to understand how service providers can help to ensure that such decisions are informed and supported by the best available supportive care thereafter.

Item Type:Article
Research Areas:A. > School of Health and Education > Institute of Nursing and Midwifery
Citations on ISI Web of Science:2
ID Code:3527
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Deposited On:31 Dec 2009 06:18
Last Modified:30 Sep 2015 15:51

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