title: Relocation of remote dwellers living with hemodialysis: a time trade-off survey.
abstract: BACKGROUND
  There has been little research exploring the experience of dialysis therapy for people living in remote communities. Remote residence location has previously been associated with excess mortality in hemodialysis (HD) patients, suggesting that relocation to a referral center might improve outcomes. It is unknown whether patients view this approach as acceptable.
  
  
  METHODS
  We studied 121 remote-dwelling chronic HD patients using the time trade-off method applied to hypothetical scenarios.
  
  
  RESULTS
  Participants indicated that they would trade a median of 6 years of life in their current location (including current social supports) (95% CI 2.25-7) for 10 years of life in a referral center without any of their existing social supports (meaning they would be willing to forgo 4 years of life to remain in their current residence location). When current social supports were assumed to continue in both locations, people were only willing to forego a median of 2 years of life (95% CI 1-4) to remain in their current location. Older participants were much less willing to accept relocation than younger participants; the median time trade-off associated with relocation and without social supports was 2 years for participants aged <50 years, 3 years for those aged 50-69.9 years and 9 years for those aged ≥70 years.
  
  
  CONCLUSIONS
  Hemodialysis patients currently living remotely were willing to forgo much of their remaining life expectancy rather than relocate-especially among older participants. These findings suggest that decisions about relocation should be accompanied by discussion of anticipated changes in quality of life and life expectancy.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Faculty of Nursing, University of Alberta, Alberta, Canada.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Molzahn
authors.affiliation: Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.affiliation: Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Sara N
authors.initials: SN
authors.lastname: Davison
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.affiliation: Department of Renewable Resources, University of Alberta, Alberta, Canada.
authors.forename: Rick
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Thompson
authors.affiliation: Department of Medicine, University of Alberta, Alberta, Canada.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Klarenbach
mesh_terms: D000368:Aged; D005260:Female; D006295:Health Resources; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: end-stage renal disease; health care services; hemodialysis; remote dwellers