BACKGROUND: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. METHOD: In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis. RESULTS: All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future. CONCLUSION: Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life.
BACKGROUND: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. METHOD: In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis. RESULTS: All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future. CONCLUSION: Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life.
Authors: Johanna Sheu; Patti L Ephraim; Neil R Powe; Hamid Rabb; Mikiko Senga; Kira E Evans; Bernard G Jaar; Deidra C Crews; Raquel C Greer; L Ebony Boulware Journal: Qual Health Res Date: 2012-07
Authors: Rachael L Morton; Paul Snelling; Angela C Webster; John Rose; Rosemary Masterson; David W Johnson; Kirsten Howard Journal: CMAJ Date: 2012-02-06 Impact factor: 8.262
Authors: Andrea Hill; Clare Ramsey; Peter Dodek; Jean Kozek; Randy Fransoo; Robert Fowler; Malcolm Doupe; Hubert Wong; Damon Scales; Allan Garland Journal: Health Serv Res Date: 2019-11-10 Impact factor: 3.402
Authors: Labib I Faruque; Brenda R Hemmelgarn; Natasha Wiebe; Braden J Manns; Pietro Ravani; Scott Klarenbach; Rick Pelletier; Marcello Tonelli Journal: Clin J Am Soc Nephrol Date: 2013-07-05 Impact factor: 8.237