TY - JOUR
T1 - Understanding pre-dialysis modality decision-making
T2 - A meta-synthesis of qualitative studies
AU - Harwood, Lori
AU - Clark, Alexander M.
N1 - Funding Information:
Decisions about dialysis modality are very significant to patients and their families. They are seen to relate to both survival and quality of life, are very personal and strongly influenced by the values of patients and their families, the context of their life and an over-riding desire to create minimal disruption to the lives of the patient and their family. These findings emphasize the need for planned and timely discussions about dialysis modality that incorporate patient and caregiver values in decision-making and whereby home-based dialysis is presented as a viable option. Support from health professionals should focus on preparation for decisions, providing knowledge of different modalities and explaining the individual implications of different modality choices on disruption to the patient and their family. Conflict of interest: None declared. Funding: Lori Harwood received funding from the Kidney Foundation of Canada 2009–2011 Allied Health Research Grants . Alexander M. Clark is supported by career awards from the Alberta Heritage Foundation for Medical Research and the Canadian Institute of Health Research .
PY - 2013
Y1 - 2013
N2 - Objectives: This systematic review examined how people with chronic kidney disease make decisions about the type of dialysis modality to use. In particular, meta-synthesis was used to understand the process of patient decision-making and how aspects of context influenced these decisions. This topic is important because home-dialysis has economic and quality of life advantages for patients and society but is underutilized. To increase the use of home-based dialysis services a greater understanding is needed of how patients make dialysis modality decisions. Design: Systematic review methods incorporating meta-synthesis were used. Data sources: Seven databases were used for the search. Eligible studies were published qualitative research studies containing extractable data on decision-making about dialysis modality selection generated from patients with chronic kidney disease. Review methods: A systematic review was conducted and the data were analyzed using meta-synthesis (also known as meta-ethnography) for qualitative research. Results: Sixteen studies were included (410 patients at various stages of chronic kidney disease). Across all the studies, decisions drew on patients' values and in the context of their situation and life. Common elements across patients' decisions were: (1) the illusion of choice - a matter of life or death, (2) minimization of the intrusiveness of dialysis on quality of life, autonomy, values, sense of self, and (3) decision-making in the context of wider knowledge and support. Conclusions: Modality decisions are highly personal and strongly influenced by patient and family values, the context of their life, and a desire for minimal intrusiveness. There is a clear need for planned and timely discussions about modalities in which home-based dialysis is presented as a viable option. Professional support should focus on patient and family preparation, knowledge of different modalities and the lifestyle implications of different modality choices.
AB - Objectives: This systematic review examined how people with chronic kidney disease make decisions about the type of dialysis modality to use. In particular, meta-synthesis was used to understand the process of patient decision-making and how aspects of context influenced these decisions. This topic is important because home-dialysis has economic and quality of life advantages for patients and society but is underutilized. To increase the use of home-based dialysis services a greater understanding is needed of how patients make dialysis modality decisions. Design: Systematic review methods incorporating meta-synthesis were used. Data sources: Seven databases were used for the search. Eligible studies were published qualitative research studies containing extractable data on decision-making about dialysis modality selection generated from patients with chronic kidney disease. Review methods: A systematic review was conducted and the data were analyzed using meta-synthesis (also known as meta-ethnography) for qualitative research. Results: Sixteen studies were included (410 patients at various stages of chronic kidney disease). Across all the studies, decisions drew on patients' values and in the context of their situation and life. Common elements across patients' decisions were: (1) the illusion of choice - a matter of life or death, (2) minimization of the intrusiveness of dialysis on quality of life, autonomy, values, sense of self, and (3) decision-making in the context of wider knowledge and support. Conclusions: Modality decisions are highly personal and strongly influenced by patient and family values, the context of their life, and a desire for minimal intrusiveness. There is a clear need for planned and timely discussions about modalities in which home-based dialysis is presented as a viable option. Professional support should focus on patient and family preparation, knowledge of different modalities and the lifestyle implications of different modality choices.
KW - Decision-making
KW - Dialysis
KW - Home hemodialysis
KW - Peritoneal dialysis
KW - Qualitative research
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=84874797680&partnerID=8YFLogxK
U2 - 10.1016/j.ijnurstu.2012.04.003
DO - 10.1016/j.ijnurstu.2012.04.003
M3 - Review article
C2 - 22560169
AN - SCOPUS:84874797680
SN - 0020-7489
VL - 50
SP - 109
EP - 120
JO - International Journal of Nursing Studies
JF - International Journal of Nursing Studies
IS - 1
ER -