title: Meanings of being a close relative of a family member treated with haemodialysis approaching end of life.
abstract: OBJECTIVE
  To describe and elucidate the meanings of being a close relative of a severely ill family member treated with maintenance haemodialysis approaching the end of life.
  
  
  BACKGROUND
  End-stage renal disease together with comorbidities, haemodialysis treatment and high mortality rates also affects the lives of close relatives, who report burdens and impaired quality of life. To improve care, more understanding is needed of close relatives' experiences during these patients' end of life.
  
  
  METHODS
  This study has a qualitative interpretative design.
  
  
  METHODS
  Fourteen retrospective qualitative interviews were conducted with close relatives (aged 48-93 years) of deceased patients who had been treated with haemodialysis. The interview text was interpreted using a phenomenological hermeneutical method in three phases.
  
  
  RESULTS
  The findings of the structural analysis were formulated as six themes: Striving to be supportive and helpful without doing harm to the ill person's self; Needing increasing strength and support; Balancing the will to help with one's own ongoing life; Increasing responsibility involving dilemmas; Striving for a good life together in the present and Living with awareness of death.
  
  
  CONCLUSIONS
  Close relatives strive for balance and well-being accompanying their ill family member through the end of life. They are facing moral dilemmas and growing demands as their responsibility increases with the deterioration of their family member. Support from and interaction with the healthcare professionals is then of significance.
  
  
  CONCLUSIONS
  Findings challenge healthcare professionals in haemodialysis settings to identify close relatives' individual resources and needs towards the patients' end of life. Healthcare professionals in haemodialysis settings need to offer close relatives opportunities to talk about the future and what may be expected at end of life, with or without haemodialysis. They should also contact the closest relative after the death as they may need confirmation and closure.
authors.affiliation: Sophiahemmet University, Stockholm, Sweden; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Axelsson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Klang
authors.forename: Carina
authors.initials: C
authors.lastname: Lundh Hagelin
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: Sissel Andreassen
authors.initials: SA
authors.lastname: Gleissman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005190:Family / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*
keywords: close relative; death; dying; end of life; end-stage renal disease; haemodialysis; phenomenological hermeneutics; qualitative interviews; retrospective interviews