None of the seven models tested proved to be an adequate fit to the data. Treatment modality was found to have a significant impact on HADS-assessed levels of anxiety and depression. CONCLSIONS: The clinical utility of the HADS in the assessment of anxiety and depression in ESRD patients may be enhanced by using the HADS total (all items) score as an index of psychological distress. Further research is required to establish the appropriateness of using the HADS to screen ESRD patients.

With the numbers of patients developing end-stage renal failure predicted to increase over the coming years, more patients than ever will be expected to choose their future form of renal replacement treatment. This study explored the decision-making processes of pre-dialysis patients to elucidate how these choices were made. Nine pre-dialysis patients were interviewed, transcripts of which were analysed using interpretative phenomenological analysis. Four main themes relating to the decision-making process emerged: maintaining one's integrity, forced adaptation, utilizing information, and support and experiencing illness. While making a decision was an individualized process, contextualized within participants' illness experiences, these core themes emerged for the whole group, irrespective of the chosen treatment modality. For renal services, there is a need to tailor information provided to pre-dialysis patients and to become cognizant of the contexts in which they live and operate.

This research has found commonalities in how families tolerate the uncertainty of the future, but also unique differences that require tailored interventions and prospective action by services.

Grounded theory as a qualitative methodology was developed by Barney G. Glaser and Anselm L. Strauss, two sociologists investigating the social processes of death and dying in hospital in the United States in the mid 1960s. Their book, The Discovery of Grounded Theory (Glaser & Strauss, 1967), explicated a rigorous set of inductively driven research strategies, designed to proceed systematically from a set of specific observations to a general conclusion or theory in order to describe and conceptualize people's views, actions and life experiences within the context in which they are lived. Their methods contrasted to dominant positivistic and quantitative forms of research at that time. Positivistic forms of research focused on experimentation and observation to empirically test and verify hypotheses as a means of describing the world in measurable variables. Glaser and Strauss highlighted qualitative methods of inquiry as a legitimate form of research in their own right. Grounded theory gained popularity in certain disciplines such as nursing over the next decade and was used in 1970s mental health research. Wilson's (1977) major mental health nursing study in the United States analysed over 200 hours of observation and interview data from a community setting for people diagnosed with schizophrenia. However, grounded theory did not begin to gain favour within psychology until another decade later. Psychologists initially conceptualized it for use within clinical and health psychology as a fruitful means of gaining alternative and in-depth perspectives of service users' experiences (e.g., Rennie et al., 1988).Glaser and Strauss each brought a unique set of assumptions to the development of grounded theory as a method: Glaser brought positivist notions of objectivity based upon his quantitative background whereas Strauss took a pragmatist stance, influenced by an interest in action, language and meaning. Whilst these epistemological differences