title: Choosing dialysis modality: decision making in a chronic illness context.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) are encouraged to make an informed decision about dialysis. Survival rates for dialysis are equivalent yet there is wide variation in peritoneal dialysis uptake in the adult UK population. It is unclear how much is attributable to variations in patients' preferences. Kidney function usually declines over months and years; few studies have addressed how a chronic illness context affects choice. This study describes patients' decision making about dialysis and understands how the experience of CKD is associated with treatment choice.
  
  
  METHODS
  Survey employing interview methods explored 20 patients' views and experiences of making their dialysis choice. Data were analysed using thematic framework analysis to provide descriptive accounts of how patients experienced their illness and made treatment decisions.
  
  
  RESULTS
  Patients talked about challenges of living with CKD. Patients were provided with lots of information about treatment options in different formats. Patients did not distinguish between different types of dialysis and/or have an in-depth knowledge about options. Patients did not talk about dialysis options as a choice but rather as a treatment they were going to have.
  
  
  CONCLUSIONS
  Most patients perceived their choice as between 'dialysis' and 'no dialysis'. They did not perceive themselves to be making an active choice. Possibly, patients feel they do not need to engage with the decision until symptomatic. Despite lots of patient information, there were more opportunities to encounter positive information about haemodialysis. A more proactive approach is required to enable patients to engage fully with the dialysis treatment options.
authors: Senior Research Fellow, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors: Anna
authors: A
authors: Winterbottom
authors: Hilary L
authors: HL
authors: Bekker
authors: Mark
authors: M
authors: Conner
authors: Andrew
authors: A
authors: Mooney
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002755:Choice Behavior; D002908:Chronic Disease / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000523:psychology*; D051436:Renal Insufficiency, Chronic / Q000523:psychology* / Q000628:therapy