Hope and advance care planning in patients with end stage renal disease: qualitative interview study.
OBJECTIVE
To understand hope in the context of advance care planning from the perspective of patients with end stage renal disease.


METHODS
Qualitative in-depth interview study.


METHODS
Outpatient department of a university affiliated nephrology programme.


METHODS
19 patients with end stage renal disease purposively selected from the renal insufficiency, haemodialysis, and peritoneal dialysis clinics.


RESULTS
Patients' hopes were highly individualised and were shaped by personal values. They reflected a preoccupation with their daily lives. Participants identified hope as central to the process of advance care planning in that hope helped them to determine future goals of care and provided insight into the perceived benefits of advance care planning and their willingness to engage in end of life discussions. More information earlier in the course of the illness focusing on the impact on daily life, along with empowerment of the patient and enhancing professional and personal relationships, were key factors in sustaining patients' ability to hope. This helped them to imagine possibilities for a future that were consistent with their values and hopes. The reliance on health professionals to initiate end of life discussions and the daily focus of clinical care were seen as potential barriers to hope.


CONCLUSIONS
Facilitated advance care planning through the provision of timely appropriate information can positively enhance rather than diminish patients' hope. Current practices concerning disclosure of prognosis are ethically and psychologically inadequate in that they do not meet the needs of patients.
Davison
Sara N
SN
Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada. sara.davison@ualberta.ca
Simpson
Christy
C
D000203:Activities of Daily Living; D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D004644:Emotions; D005195:Family Relations; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011369:Professional-Patient Relations