Pawar AS, Thorsteinsdottir B, Whitman S, Pine K, Lee A, Espinoza Suarez NR, Organick Lee P, Thota A, Lorenz E, Beck A, Albright R, Feely M, Williams A, Behnken E, Boehmer KR. Decisional Regret Surrounding Dialysis Initiation: A Comparative Analysis.
Kidney Med 2024;
6:100785. [PMID:
38435065 PMCID:
PMC10907211 DOI:
10.1016/j.xkme.2023.100785]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/20/2023] [Accepted: 11/19/2023] [Indexed: 03/05/2024] Open
Abstract
Rationale & Objective
Dialysis comes with a substantial treatment burden, so patients must select care plans that align with their preferences. We aimed to deepen the understanding of decisional regret with dialysis choices.
Study Design
This study had a mixed-methods explanatory sequential design.
Setting & Participants
All patients from a single academic medical center prescribed maintenance in-center hemodialysis or presenting for home hemodialysis or peritoneal dialysis check-up during 3 weeks were approached for survey. A total of 78 patients agreed to participate. Patients with the highest (15 patients) and lowest decisional regret (20 patients) were invited to semistructured interviews.
Predictors
Decisional regret scale and illness intrusiveness scale were used in this study.
Analytical Approach
Quantitatively, we examined correlations between the decision regret scale and illness intrusiveness scale and sorted patients into the highest and lowest decision regret scale quartiles for further interviews; then, we compared patient characteristics between those that consented to interview in high and low decisional regret. Qualitatively, we used an adapted grounded theory approach to examine differences between interviewed patients with high and low decisional regret.
Results
Of patients invited to participate in the interviews, 21 patients (8 high regret, 13 low regret) agreed. We observed that patients with high decisional regret displayed resignation toward dialysis, disruption of their sense of self and social roles, and self-blame, whereas patients with low decisional regret demonstrated positivity, integration of dialysis into their identity, and self-compassion.
Limitations
Patients with the highest levels of decisional regret may have already withdrawn from dialysis. Patients could complete interviews in any location (eg, home, dialysis unit, and clinical office), which may have influenced patient disclosure.
Conclusions
Although all patients experienced disruption after dialysis initiation, patients' approach to adversity differs between patients experiencing high versus low regret. This study identifies emotional responses to dialysis that may be modifiable through patient-support interventions.
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