title: Why don't they accept non-invasive ventilation?: insight into the interpersonal perspectives of patients with motor neurone disease.
abstract: OBJECTIVE
  Although non-invasive ventilation (NIV) can benefit survival and quality of life, it is rejected by a substantial proportion of people with motor neurone disease (MND). The aim of this study was to understand why some MND patients decline or withdraw from NIV.
  
  
  METHODS
  Nine patients with MND (male = 7, mean age = 67 years) participated in this study. These patients, from a cohort of 35 patients who were offered NIV treatment to support respiratory muscle weakness, did not participate in NIV treatment when it was clinically appropriate. Semi-structured interviews and interpretative phenomenological analysis (IPA) were employed to explore these patient's experience of MND and their thoughts and understanding of NIV treatment.
  
  
  RESULTS
  Using IPA, four themes were identified: preservation of the self, negative perceptions of NIV, negative experience with health care services, and not needing NIV. Further analysis identified the fundamental issue to be the maintenance of perceived self, which was interpreted to consist of the sense of autonomy, dignity, and quality of life.
  
  
  CONCLUSIONS
  The findings indicate psychological reasons for disengagement with NIV. The threat to the self, the sense of loss of control, and negative views of NIV resulting from anxiety were more important to these patients than prolonging life in its current form. These findings suggest the importance of understanding the psychological dimension involved in decision-making regarding uptake of NIV and a need for sensitive holistic evaluation if NIV is declined. Statement of contribution What is already known on this subject? Non-invasive ventilation is widely used as an effective symptomatic therapy in MND, yet about a third of patients decline the treatment. Psychological disturbance generated by NIV use leads to negative experiences of the treatment. Decision-making about treatment potentials is complex and unique to each individual affected by perceived impact of disease. What does this study add? A decision concerning NIV uptake was influenced by perceived impact on individuals' sense of self. Sense of self was influenced by the maintenance of autonomy, dignity, and quality of life. Individuals' sense of self was identified to have been challenged by the disease, NIV, and their experience of health care service.
authors.affiliation: Department of Psychology, Liverpool Hope University, UK; Chest Centre, Aintree University Hospital, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK.
authors.forename: Hikari
authors.initials: H
authors.lastname: Ando
authors.forename: Carl
authors.initials: C
authors.lastname: Williams
authors.forename: Robert M
authors.initials: RM
authors.lastname: Angus
authors.forename: Everard W
authors.initials: EW
authors.lastname: Thornton
authors.forename: Biswajit
authors.initials: B
authors.lastname: Chakrabarti
authors.forename: Rosanna
authors.initials: R
authors.lastname: Cousins
authors.forename: Lucy H
authors.initials: LH
authors.lastname: Piggin
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000523:psychology* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: motor neurone disease/amyotrophic lateral sclerosis; non-invasive ventilation; qualitative research; quality of life; treatment decision