title: Perspectives of patients, families, and health care professionals on decision-making about dialysis modality--the good, the bad, and the misunderstandings!
abstract: OBJECTIVE
  This study explored the factors influencing decision-making about dialysis modality, integrating the perspectives of patients, their families, and health care professionals within an Asian population. The study further sought to understand the low penetration rate of peritoneal dialysis (PD) in Singapore. ♢
  
  
  METHODS
  A sample of 59 participants comprising pre-dialysis patients, dialysis patients, caregivers, and health care professionals (HCPs) participated in semi-structured interviews to explore the decision-making process and their views about various dialysis modalities. Data were thematically analyzed using NVivo9 (QSR International, Doncaster, Australia) to explore barriers to and facilitators of various dialysis modalities and decisional support needs. ♢
  
  
  RESULTS
  Fear of infection, daily commitment to PD, and misperceptions of PD emerged as barriers to PD. Side effects, distance to dialysis centers, and fear of needling and pain were barriers to hemodialysis (HD). The experiences of other patients, communicated informally or opportunistically, influenced the preferences and choices of patients and family members for a dialysis modality. Patients and families value input from HCPs and yet express strong needs to discuss subjective experiences of life on dialysis (PD or HD) with other patients before making a decision about dialysis modality. ♢
  
  
  CONCLUSIONS
  Pre-dialysis education should expand its focus on the family as the unit of care and should provide opportunities for interaction with dialysis patients and for peer-led learning. Barriers to PD, especially misperceptions and misunderstandings, can be targeted to improve PD uptake.
authors.affiliation: Department of Psychology, National University of Singapore, 117570 Singapore.
authors.forename: Konstadina
authors.initials: K
authors.lastname: Griva
authors.forename: Zhi Hui
authors.initials: ZH
authors.lastname: Li
authors.forename: Alden Yuanhong
authors.initials: AY
authors.lastname: Lai
authors.forename: Meng Chan
authors.initials: MC
authors.lastname: Choong
authors.forename: Marjorie Wai Yin
authors.initials: MW
authors.lastname: Foo
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D011368:Professional-Family Relations; D006435:Renal Dialysis / Q000379:methods* / Q000523:psychology; D012846:Singapore; D055815:Young Adult
keywords: Decision-making; dialysis modality; patient education