Patient and Health Care Professional Decision-Making to Commence and Withdraw from Renal Dialysis: A Systematic Review of Qualitative Research

摘要: Background and objective To ensure that decisions to start stop dialysis in ESRD are shared, the factors affect patients health care professionals making such must be understood. This systematic review sought explore how why different mediate choices about treatment. Design, setting, participants, & measurements MEDLINE, Embase, CINAHL, PsychINFO were searched for qualitative studies of patients’ or professionals’ commence withdraw from dialysis. A thematic synthesis was conducted. Results Of 494 articles screened, 12 (conducted 1985 2014) included. These involved 206 (most receiving hemodialysis) 64 (age ranges: patients, 26–93 years; professionals, 26–61 years). For commencing dialysis, based their choice on "gut instinct," as well deliberating over effect treatment quality life survival. How individuals coped with decision-making influential: Some tried take control problem progressive renal failure, whereas others focused controlling emotions. Health weighed biomedical led by an instinct prolong life. Both described feeling powerless. With regard withdrawal, only after prolonged periods realities fully appreciated past questioned. By this stage, however, physically dependent As seen withdrawal a problem- emotion-controlling way. Families struggled differentiate between choosing versus allowing death. teams avoided queried discussions regarding withdrawal. Patients, missed dialogue they experienced during predialysis education. Conclusions Decision-making is complex dynamic evolves time toward The at work multifaceted operate differently professionals. More training research open communication shared needed.