GRADE profile 1Patient and carer perspective (adults)

Quality assessmentSummary of findingsQuality
No. of studiesStudy designLimitationsInconsistencyIndirectnessImprecision
Patient and carer perspective (adults)
Morton 2010
Systematic reviewNo serious limitationsNo serious inconsistenciesNo serious indirectnessNot relevantIdentified themes were:
  • confronting mortality
  • lack of choice
  • gaining knowledge of options
  • weighing alternatives
Major factors influencing decision-making were:
  • peer influence
  • timing of information
  • maintaining the status quo
Murray 2009
Systematic reviewNo serious limitationsNo serious inconsistenciesNo serious indirectnessNot relevantMost frequent decisions were: Reported information were:
  • condition management
  • social and lifestyle factors
  • general knowledge about CKD, treatment options and renal transplant
  • lifestyle management
  • self-care
  • end-of-life planning
  • exposure to others’ opinions and experiences.
Patient-level factors influencing treatment decisions were:
  • interpersonal relationships
  • trust in providers
  • preservation of current well being, normality and quality of life
  • need for control
  • being personally responsible.
Lee 2008
McLaughlin 2008
Morton 2010
Qualitative studiesSome serious limitationsaNo serious inconsistenciesNo serious indirectnessNot relevantIdentified themes were:
  • flexibility and independence or confinement
  • freedom and control or risk and subordination
  • self-care
  • feelings of insecurity or security
  • physical space and noise and home modification
  • maintenance of a normal life
  • lifestyle
  • social inclusion or family burden
  • convenience or time commitment
  • pre-dialysis information
  • involvement in choice of modality
  • effectiveness
  • simplicity
  • pain
  • access
  • impermanence.

It was not possible to synthesise these data, as was done in the high quality systematic reviews (downgraded one level).

Abbreviations: RRT, renal replacement therapy.

From: 3, How this guideline was developed

Cover of Peritoneal Dialysis
Peritoneal Dialysis: Peritoneal Dialysis in the Treatment of Stage 5 Chronic Kidney Disease.
NICE Clinical Guidelines, No. 125.
Centre for Clinical Practice at NICE (UK).
Copyright © 2011, National Institute for Health and Clinical Excellence.

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