Cassidy BP, Harwood L, Getchell LE, Smith M, Sibbald SL, Moist LM. Educational Support Around Dialysis Modality Decision Making in Patients With Chronic Kidney Disease: Qualitative Study.
Can J Kidney Health Dis 2018;
5:2054358118803323. [PMID:
30327720 PMCID:
PMC6178119 DOI:
10.1177/2054358118803323]
[Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND
Patients with chronic kidney disease (CKD) are asked to choose a renal replacement therapy or conservative management. Education and knowledge transfer play key roles in this decision-making process, yet they remain a partially met need.
OBJECTIVE
We sought to understand the dialysis modality decision-making process through exploration of the predialysis patient experience to better inform the educational process.
DESIGN
Qualitative descriptive study.
SETTING
Kidney Care Centre of London Health Sciences Centre in London, Ontario, Canada.
PATIENTS
Twelve patients with CKD, with 4 patients on in-center hemodialysis, home hemodialysis, and peritoneal dialysis, respectively.
MEASUREMENTS
Not applicable.
METHODS
We conducted semistructured interviews with each participant, along with any family members who were present. Interviews were transcribed verbatim. Conventional content analysis was used to analyze the transcripts for common themes. Representative quotes were decided via team consensus. A patient collaborator was part of the research team.
RESULTS
Three themes influenced dialysis modality decision making: (i) Patient Factors: individualization, autonomy, and emotions; (ii) Educational Factors: tailored education, time and preparation, and available resources; and (iii) Support Systems: partnership with health care team, and family and friends.
LIMITATIONS
Sample not representative of wider CKD population. Limited number of eligible patients. Poor recall may affect findings.
CONCLUSIONS
Modality decision making is a complex process, influenced by the patient's health literacy, willingness to accept information, predialysis lifestyle, support systems, and values. Patient education requires the flexibility to individualize the delivery of a standardized CKD curriculum in partnership with a patient-health care team, to fulfill the goal of informed, shared decision making.
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