title: Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease.
abstract: BACKGROUND
  Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy.
  
  
  METHODS
  In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis.
  
  
  RESULTS
  All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future.
  
  
  CONCLUSIONS
  Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life.
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. annemieke.visser@med.umcg.nl
authors.forename: Annemieke
authors.initials: A
authors.lastname: Visser
authors.forename: Geke J
authors.initials: GJ
authors.lastname: Dijkstra
authors.forename: Daphne
authors.initials: D
authors.lastname: Kuiper
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Casper F M
authors.initials: CF
authors.lastname: Franssen
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.forename: Gerbrand J
authors.initials: GJ
authors.lastname: Izaks
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D017028:Caregivers; D002755:Choice Behavior; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D017533:Marital Status; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000523:psychology; D012737:Sex Factors; D016312:Treatment Refusal