TY - JOUR
T1 - Dialysis modality decision-making for older adults with chronic kidney disease
AU - Harwood, Lori
AU - Clark, Alexander M.
N1 - Publisher Copyright:
© 2014 John Wiley & Sons Ltd.
PY - 2014/12/1
Y1 - 2014/12/1
N2 - Aims and objectives: To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease. Background: Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-dialysis despite its benefits. Design: This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age. Methods: Thirteen people (seven men and six women, aged 65-83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis. Results: The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home-dialysis selection. Conclusion: The social and contextual factors associated with age influenced home-dialysis decision-making. Adequate social support, functional status and resources enabled home-dialysis selection. Relevance to clinical practice: Understanding more about the decision-making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services.
AB - Aims and objectives: To examine the personal and structural facilitators and barriers for home-dialysis decision-making for older adults with chronic kidney disease. Background: Chronic illness is a global problem. Older adults with chronic kidney disease form a large and growing segment of the dialysis population in many high-income countries but are less likely to uptake home-dialysis despite its benefits. Design: This qualitative ethnography framed in social theory took place in Canada and included adults with chronic kidney disease not on dialysis, older than 65 years of age. Methods: Thirteen people (seven men and six women, aged 65-83 years of age) who received care in a team chronic kidney disease clinic took part. Persons with chronic kidney disease were interviewed and group interviews were conducted with four of their chronic kidney disease clinic healthcare professionals. Content analysis was used for data analysis. Results: The factors influencing older adults' chronic kidney disease modality decisions are similar to younger adults. However, older adults with chronic kidney disease are in a precarious state with persistent uncertainty. Age imposes some limitations on modality options and transplantation. Modality decisions were influenced by health status, gender, knowledge, values, beliefs, past experience, preferences, lifestyle and resources. Support from family and healthcare professionals was the largest determinant to home-dialysis selection. Conclusion: The social and contextual factors associated with age influenced home-dialysis decision-making. Adequate social support, functional status and resources enabled home-dialysis selection. Relevance to clinical practice: Understanding more about the decision-making processes for older adults with chronic kidney disease is important for quality interventions and the economic sustainability of dialysis services.
KW - Chronic kidney disease
KW - Critical realism
KW - Decision-making
KW - Home-dialysis
UR - http://www.scopus.com/inward/record.url?scp=84926154501&partnerID=8YFLogxK
U2 - 10.1111/jocn.12582
DO - 10.1111/jocn.12582
M3 - Journal Article
C2 - 24646195
AN - SCOPUS:84926154501
SN - 0962-1067
VL - 23
SP - 3378
EP - 3390
JO - Journal of Clinical Nursing
JF - Journal of Clinical Nursing
IS - 23-24
ER -