title: Selection of peritoneal dialysis among older eligible patients with end-stage renal disease.
abstract: Older patients with end-stage renal disease (ESRD) are less likely to choose peritoneal dialysis (PD) over hemodialysis (HD). The reasons behind their choice of dialysis modality are not clear. This study seeks to determine the patient-perceived factors that influence ESRD patients' choice of dialysis modality among older ESRD patients who are deemed eligible for both PD and HD.
  
  
  
  All patients had completed a multidisciplinary modality assessment, were deemed eligible for both PD and HD, and had received modality education. Semi-structured interviews were conducted and transcripts were read repeatedly to derive potential codes using line-by-line textual analysis. The Capability, Opportunity, Motivation – Behaviour (COM-B) and Theoretical Domain Framework (TDF), validated tools that were developed for designing behavioral change interventions, were used to help guide the coding framework.
  
  
  
  Among older ESRD patients who are deemed eligible for both PD and HD, factors relevant to their modality decision-making were identified with respect to physical strength/dexterity and having a sound mind (capability), external forces and constraints (opportunity), and values and beliefs (motivation). Often a combination of factors led to an individual's choice of a particular dialysis modality. However, preferences for PD were primarily based around convenience and maintaining a normal life, while a heightened sense of security was the primary reason for those who selected HD.
  
  
  
  We have identified patient-perceived factors that influence choice of dialysis modality in older individuals with ESRD who are eligible for PD and HD. These factors should be considered and/or addressed within PD programs seeking to promote PD.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.|Department of Medicine, Headwaters Health Care Centre, Orangeville, ON, Canada.
authors.forename: Ben
authors.initials: B
authors.lastname: Wong
authors.affiliation: Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Venturato
authors.affiliation: Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Jayna
authors.initials: J
authors.lastname: Holroyd-Leduc
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000379:methods*; D011379:Prognosis
keywords: decision-making; interview; modality selection; peritoneal dialysis; qualitative research