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

Autor:	Lovell S; School of Health Sciences, University of Canterbury, Christchurch, New Zealand., Walker RJ; Department of Medicine, University of Otago, Dunedin, New Zealand., Schollum JB; Department of Medicine, University of Otago, Dunedin, New Zealand., Marshall MR; Department of Renal Medicine, Counties Manukau Health, Auckland, New Zealand.; School of Medicine, University of Auckland, Auckland, New Zealand.; Medical Affairs, Baxter Healthcare (Asia) Pte Ltd, Singapore., McNoe BM; Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand., Derrett S; Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2017 Mar 29; Vol. 7 (3), pp. e014781. Date of Electronic Publication: 2017 Mar 29.
DOI:	10.1136/bmjopen-2016-014781
Abstrakt:	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. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
Databáze:	MEDLINE
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