Priority dilemmas in dialysis: the impact of old age.
OBJECTIVE
This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.


BACKGROUND
Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.


METHODS
A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. The informants were five physicians and four nurses from dialysis wards.


RESULTS
Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.


CONCLUSIONS
Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated.
Halvorsen
K
K
Department of General Practice and Community Medicine, Section for Medical Ethics, University of Oslo, PB 1130 Blindern, NO-0318 Oslo, Norway. kristin.halvorsen@medisin.uio.no
Slettebø
A
A
Nortvedt
P
P
Pedersen
R
R
Kirkevold
M
M
Nordhaug
M
M
Brinchmann
B S
BS
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008020:Life Support Care / Q000295:instrumentation; D008297:Male; D009664:Norway; D010817:Physician-Patient Relations / Q000941:ethics; D011634:Public Health / Q000941:ethics; D006435:Renal Dialysis / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*