Understanding health decisions using critical realism: Home-dialysis decision-making during chronic kidney disease

Lori Harwood, Alexander M. Clark

    Research output: Contribution to journalJournal Articlepeer-review

    18 Citations (Scopus)

    Abstract

    This paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology.

    Original languageEnglish
    Pages (from-to)29-38
    Number of pages10
    JournalNursing Inquiry
    Volume19
    Issue number1
    DOIs
    Publication statusPublished - Mar. 2012

    Keywords

    • Chronic illness
    • Decision-making
    • Social theory

    Fingerprint

    Dive into the research topics of 'Understanding health decisions using critical realism: Home-dialysis decision-making during chronic kidney disease'. Together they form a unique fingerprint.

    Cite this