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BMJ Open. 2017 Mar 29;7(3):e014781. doi: 10.1136/bmjopen-2016-014781.

To dialyse or delay: a qualitative study of older New Zealanders' perceptions and experiences of decision-making, with stage 5 chronic kidney disease.

Author information

1
School of Health Sciences, University of Canterbury, Christchurch, New Zealand.
2
Department of Medicine, University of Otago, Dunedin, New Zealand.
3
Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand.
4
School of Medicine, University of Auckland, Auckland, New Zealand.
5
Medical Affairs, Baxter Healthcare (Asia) Pte Ltd, Singapore.
6
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.

Abstract

BACKGROUND:

Issues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing.

STUDY POPULATION:

Participants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand. All participants had reached chronic kidney disease (CKD) stage 5 and had undergone dialysis education but had not started dialysis or recently started dialysis within the past 6 months.

METHODOLOGY:

Serial qualitative interviews were undertaken to explore the decision-making processes and subsequent treatment experiences of patients with ESKD.Analytical approach: A framework method guided the iterative process of analysis. Decision-making codes were generated within NVivo software and then compared with the body of the interviews.

RESULTS:

Interviews were undertaken with 17 participants. We observed that decision-making was often a fluid process, rather than occurring at a single point in time, and was heavily influenced by perceptions of oneself as becoming old, social circumstances, life events and health status.

LIMITATIONS:

This study focuses on participants' experiences of decision-making about treatment and does not include perspectives of their nephrologists or other members of the nephrology team.

CONCLUSIONS:

Older patients often delay dialysis as an act of self-efficacy. They often do not commit to a dialysis decision following predialysis education. Delaying decision-making and initiating dialysis were common. This was not seen by participants as a final decision about therapy. Predialysis care and education should be different for older patients, who will delay decision-making until the time of facing obvious uraemic symptoms, threatening blood tests or paternalistic guidance from their nephrologist.

TRIAL REGISTRATION NUMBER:

Australasian Clinical Trials Registry ACTRN 12611000024943; results.

KEYWORDS:

Elderly; QUALITATIVE RESEARCH; decision-making

PMID:
28360253
PMCID:
PMC5372046
DOI:
10.1136/bmjopen-2016-014781
[Indexed for MEDLINE]
Free PMC Article

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