title: Patients' perceptions of why, how, and by whom dialysis treatment modality was chosen.
abstract: OBJECTIVE
  The purpose of this qualitative study was to elicit patients' perceptions of why, how, and by whom their dialysis treatment modality--hemodialysis or continuous ambulatory peritoneal dialysis (CAPD)--was chosen.
  
  
  METHODS
  The study design utilized a naturalistic method of inquiry employing a qualitative approach. The research was guided by the life-death decisions in health care framework developed by Degner and Beaton and the Neuman Systems Model.
  
  
  METHODS
  Twenty-two informants were recruited from inpatient and outpatient renal dialysis units at a large urban tertiary care center on the east coast of the United States.
  
  
  METHODS
  Data were collected by individual, focused, semi-structured in-depth interviews.
  
  
  RESULTS
  A grounded theory, "Patient's Choice of a Treatment Modality versus Selection of Patient's Treatment Modality" emerged from the data provided by the informants. The theory consisted of 11 themes that addressed the why, how, and by whom of decision-making: self decision; access-rationing decision; significant other decision; to live decision; physiologically dictated decision; expert decision; to-be-cared-for decision; independence verses dependence decision; no patient choice in making decision; patient preference/choice; and switching modalities due to patient preference/choice.
  
  
  CONCLUSIONS
  The themes reflected two patterns of decision-making: the patient and/or significant other chose the treatment modality, and the treatment modality was selected because of clinical or practical circumstances.
authors.affiliation: Center for Advancing Care in Serious Illness, University of Pennsylvania School of Nursing, Philadelphia, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Breckenridge
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003657:Decision Making; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D015404:Nursing Methodology Research; D018579:Patient Selection; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology*; D011795:Surveys and Questionnaires