Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Abstract

Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study

“…Conversely, patients' experience of gradually worsening symptoms that impeded their daily life shifted the balance in favour of dialysis. These results correspond with studies in other countries as well as a qualitative study in Singapore which found that major factors driving patients to decline dialysis included age and life completion, financial and physical costs of dialysis, and the perceived pain and suffering caused by dialysis . Our study adds that many older ESRD patients in Singapore seek alternative medicine such as traditional Chinese medicine (TCM) as a means to delay dialysis, and the main reason why many eventually decide to start dialysis despite initial rejection is to relieve intensifying symptom burden (rather than to extend their lives).…”

A national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure

“…Reluctance to think about the future and feeling well without dialysis have been identified in previous studies 37,38,43 and they linked to the current findings about perceptions of CKD severity and revising decisions. Feeling well, with few symptoms, seemed to make some patients think their CKD was less severe, which meant they did not see a reason to consider dialysis.…”

“…[36][37][38][39] Patients who reported making an autonomous decision gave the following reasons: they felt they were too old for dialysis, they thought dialysis was too strenuous for them to undertake, they felt well without dialysis, they did not want to be a burden on their family, they knew other patients who had had bad experiences on dialysis and they found it difficult to travel to dialysis. [36][37][38][39] In addition, some patients believed they had no decision to make if they were told dialysis was unsuitable for them. 36 Researchers also identified that some patients were reluctant to think about the future, which meant decision-making about treatment potentially needed in the future was difficult.…”

“…[36][37][38][39] CKM patients reported that they had chosen CKM because they felt too old for dialysis, they were worried about being a burden on family/society and they were concerned about travelling to have dialysis. While these factors can be valid reasons for making a decision there is also a sense that some patients may feel dialysis is not really a possibility or that they do not have a right to dialysis.…”

Factors Associated with Initiation of Chronic Renal Replacement Therapy for Patients with Kidney Failure

“…Given the potential burden of repeated travel to receive dialysis treatment (and because dialysis was much more common than pre-emptive transplantation), it was not surprising that remote-dwelling patients were less likely to initiate RRT than those living closer. In fact, qualitative studies of patients with advanced kidney failure suggest that prolonged travel to a distant facility is an important potential barrier to accepting dialysis treatment (20,33,35,36). Our previous work shows that the likelihood of untreated kidney failure is substantially higher among older adults than in otherwise similar younger patients (37); this study extends these findings by highlighting how the likelihood of initiating RRT varies with the presence of other clinical characteristics including sex, comorbidity, and residence location.…”