title: Experiences of carers supporting dying renal patients managed without dialysis.
abstract: OBJECTIVE
  To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis.
  
  
  BACKGROUND
  Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers.
  
  
  METHODS
  Exploratory, qualitative design.
  
  
  METHODS
  The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006-2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis.
  
  
  RESULTS
  'Caring from diagnosis to death' was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight - making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. 'Caring from diagnosis to death' coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness.
  
  
  CONCLUSIONS
  There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.
authors.affiliation: Health Services Research, School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre, UK. helen.noble@qub.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Noble
authors.forename: Daniel
authors.initials: D
authors.lastname: Kelly
authors.forename: Peter
authors.initials: P
authors.lastname: Hudson
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology; D005260:Female; D006701:Home Nursing; D006801:Humans; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010166:Palliative Care; D036301:Qualitative Research; D012944:Social Support; D035501:Uncertainty; D006113:United Kingdom