title: Opting out of dialysis – Exploring patients' decisions to forego dialysis in favour of conservative non-dialytic management for end-stage renal disease.
abstract: BACKGROUND
  Dialysis prolongs the life of people with end-stage renal disease (ESRD), but for patients who are elderly and suffer multiple comorbid illnesses the benefits of dialysis may be outweighed by its negative consequences. Non-dialytic conservative management has therefore become an alternative treatment route, yet little is known on patients' experience with choosing end-of-life treatment.
  
  
  OBJECTIVE
  To gain insight into the decision-making process leading to opting out of dialysis and the experience with conservative non-dialytic management from the patients' perspective.
  
  
  METHODS
  Qualitative study using semi-structured interviews. Interpretative phenomenological analysis was undertaken as the framework for data analysis.
  
  
  METHODS
  N = 9 ESRD participants who have taken the decision to forego dialysis were recruited from the advanced care programme under the National Healthcare Group, Singapore.
  
  
  RESULTS
  Participants discussed life since ESRD diagnosis, and the personal and contextual factors that led them to choose conservative management. The perceived physical and financial burden of dialysis both for the individual but most importantly for their family, uncertainty over likely gains over risks which were fuelled by communication of negative dialysis stories of others, coupled with sense of life completion and achievement led them to refuse dialysis. All participants took ownership of their decision despite contrary advice by doctors and were content with their decision and current management.
  
  
  CONCLUSIONS
  Study highlights the factors driving patients' decisions for conservative non-dialytic management over dialysis to allow medical professionals to offer appropriate support to patients through their decision-making process and in caring them for the rest of their lives.
authors: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.|Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.
authors: Angeline S T
authors: AS
authors: Seah
authors: Institute of Mental Health, Singapore, Singapore.
authors: Fiona
authors: F
authors: Tan
authors: Division of Renal Medicine, Department of Medicine, National University of Singapore, Singapore, Singapore.|Department of Medicine, National University of Singapore, Singapore, Singapore.|Division of Nephrology, National University Health System, Singapore, Singapore.
authors: Subramaniam
authors: S
authors: Srinivas
authors: Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors: Huei Yei
authors: HY
authors: Wu
authors: Department of Psychology, National University of Singapore, Singapore, Singapore.
authors: Konstadina
authors: K
authors: Griva
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010348:Patient Care Team; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects; D012846:Singapore; D016312:Treatment Refusal / Q000523:psychology*
keywords: conservative management; decision-making; dialysis; palliative
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