The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies
- The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies
- Morton RL, Tong A, Howard K, Snelling P, Webster AC
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Objective To synthesise the views of patients and carers indecision making regarding treatment for chronic kidney disease,and to determine which factors influence those decisions. Design Systematic review of qualitative studies of decisionmaking and choice for dialysis, transplantation, or palliativecare, and thematic synthesis of qualitative studies. Data sources Medline, PsycINFO, CINAHL, Embase, social workabstracts, and digital theses (database inception to week 3October 2008) to identify literature using qualitative methods(focus groups, interviews, or case studies). Review methods Thematic synthesis involved line by line codingof the findings of the primary studies and development of descriptiveand analytical themes. Results 18 studies that reported the experiences of 375 patientsand 87 carers were included. 14 studies focused on preferencesfor dialysis modality, three on transplantation, and one onpalliative management. Four major themes were identified asbeing central to treatment choices: confronting mortality (choosinglife or death, being a burden, living in limbo), lack of choice(medical decision, lack of information, constraints on resources),gaining knowledge of options (peer influence, timing of information),and weighing alternatives (maintaining lifestyle, family influences,maintaining the status quo). Conclusions The experiences of other patients greatly influencedthe decision making of patients and carers. The problematictiming of information about treatment options and synchronouscreation of vascular access seemed to predetermine haemodialysisand inhibit choice of other treatments, including palliativecare. A preference to maintain the status quo may explain whypatients often remain on their initial therapy.
The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies Morton RL, Tong A, Howard K, Snelling P, Webster AC. BMJ 2010; 340:c112.