Choosing dialysis modality: decision making in a chronic illness context
Corresponding Author
Anna Winterbottom PhD
Senior Research Fellow, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
Correspondence
Anna Winterbottom
Leeds Institute for Health Sciences
Charles Thakrah Building – Room 2.03
101 Clarendon Way
Leeds LS2 9LJ
UK
E-mail: [email protected]
Search for more papers by this authorHilary L Bekker PhD
Senior Lecturer, in Behavioural Sciences, Leeds Institute of Health Sciences University of Leeds, Leeds, UK
Search for more papers by this authorMark Conner PhD
Professor of Applied Social Psychology, Leeds Institute of Psychological Sciences, University of Leeds, Leeds, UK
Search for more papers by this authorAndrew Mooney FRCP, PhD
Adult Renal Services, St James's University Hospital, Leeds, UK
Search for more papers by this authorCorresponding Author
Anna Winterbottom PhD
Senior Research Fellow, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
Correspondence
Anna Winterbottom
Leeds Institute for Health Sciences
Charles Thakrah Building – Room 2.03
101 Clarendon Way
Leeds LS2 9LJ
UK
E-mail: [email protected]
Search for more papers by this authorHilary L Bekker PhD
Senior Lecturer, in Behavioural Sciences, Leeds Institute of Health Sciences University of Leeds, Leeds, UK
Search for more papers by this authorMark Conner PhD
Professor of Applied Social Psychology, Leeds Institute of Psychological Sciences, University of Leeds, Leeds, UK
Search for more papers by this authorAndrew Mooney FRCP, PhD
Adult Renal Services, St James's University Hospital, Leeds, UK
Search for more papers by this authorAbstract
Background
Patients with chronic kidney disease (CKD) are encouraged to make an informed decision about dialysis. Survival rates for dialysis are equivalent yet there is wide variation in peritoneal dialysis uptake in the adult UK population. It is unclear how much is attributable to variations in patients' preferences. Kidney function usually declines over months and years; few studies have addressed how a chronic illness context affects choice. This study describes patients' decision making about dialysis and understands how the experience of CKD is associated with treatment choice.
Method
Survey employing interview methods explored 20 patients' views and experiences of making their dialysis choice. Data were analysed using thematic framework analysis to provide descriptive accounts of how patients experienced their illness and made treatment decisions.
Results
Patients talked about challenges of living with CKD. Patients were provided with lots of information about treatment options in different formats. Patients did not distinguish between different types of dialysis and/or have an in-depth knowledge about options. Patients did not talk about dialysis options as a choice but rather as a treatment they were going to have.
Conclusion
Most patients perceived their choice as between ‘dialysis’ and ‘no dialysis’. They did not perceive themselves to be making an active choice. Possibly, patients feel they do not need to engage with the decision until symptomatic. Despite lots of patient information, there were more opportunities to encounter positive information about haemodialysis. A more proactive approach is required to enable patients to engage fully with the dialysis treatment options.
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