title: Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study.
abstract: OBJECTIVE
  This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.
  
  
  BACKGROUND
  Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.
  
  
  METHODS
  Qualitative practitioner research study.
  
  
  METHODS
  Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.
  
  
  RESULTS
  Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.
  
  
  CONCLUSIONS
  Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.
  
  
  CONCLUSIONS
  Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.
authors.affiliation: Royal Free Hampstead NHS Trust, London, UK. sheilaJohnston@nhs.net
authors.forename: Sheila
authors.initials: S
authors.lastname: Johnston
authors.forename: Helen
authors.initials: H
authors.lastname: Noble
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000451:nursing* / Q000628:therapy; D008297:Male; D009722:Nurse Practitioners; D024802:Nurse's Role; D006435:Renal Dialysis