title: Why take the chance? A qualitative grounded theory study of nocturnal haemodialysis recipients who decline kidney transplantation.
abstract: The objective of this study was to examine the factors that influence decision-making to forgo transplantation in favour of remaining on nocturnal haemodialysis (NHD).
  
  
  
  A grounded theory approach using in-depth telephone interviewing was used.
  
  
  
  Participants were identified from 2 tertiary care renal programmes in Canada.
  
  
  
  The study participants were otherwise eligible patients with end-stage renal disease who have opted to remain off of the transplant list. A total of 7 eligible participants were interviewed. 5 were male. The mean age was 46 years.
  
  
  
  A constant comparative method of analysis was used to identify a core category and factors influencing the decision-making process.
  
  
  
  In this grounded theory study of people receiving NHD who refused kidney transplantation, the core category of 'why take a chance when things are going well?' was identified, along with 4 factors that influenced the decision including 'negative past experience', 'feeling well on NHD', 'gaining autonomy' and 'responsibility'.
  
  
  
  This study provides insight into patients' thought processes surrounding an important treatment decision. Such insights might help the renal team to better understand, and thereby respect, patient choice in a patient-centred care paradigm. Findings may also be useful in the development of education programmes addressing the specific concerns of this population of patients.
authors.affiliation: Department of Pharmacy Administration, University of Mississippi, Oxford, Mississippi, USA.
authors.forename: Meagen M
authors.initials: MM
authors.lastname: Rosenthal
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Anita E
authors.initials: AE
authors.lastname: Molzahn
authors.affiliation: Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Chan
authors.affiliation: Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Cockfield
authors.affiliation: Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Pauly
mesh_terms: D000328:Adult; D003657:Decision Making; D004032:Diet; D005260:Female; D066296:Grounded Theory; D006304:Health Status; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007407:Interviews as Topic; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D026684:Personal Autonomy; D036301:Qualitative Research; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology*; D012648:Self Care; D016312:Treatment Refusal / Q000523:psychology*; D035501:Uncertainty
keywords: Decision-making; grounded theory; nocturnal hemodialysis