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首页> 外文期刊>Health expectations: an international journal of public participation in health care and health policy >Opting out of dialysis – Exploring patients' decisions to forego dialysis in favour of conservative non‐dialytic management for end‐stage renal disease
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Opting out of dialysis – Exploring patients' decisions to forego dialysis in favour of conservative non‐dialytic management for end‐stage renal disease

机译：选择不进行透析–探索患者放弃透析的决定，转而采用保守的非透析治疗晚期肾病

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Background Dialysis prolongs the life of people with end‐stage renal disease ( ESRD ), but for patients who are elderly and suffer multiple comorbid illnesses the benefits of dialysis may be outweighed by its negative consequences. Non‐dialytic conservative management has therefore become an alternative treatment route, yet little is known on patients' experience with choosing end‐of‐life treatment. Aims To gain insight into the decision‐making process leading to opting out of dialysis and the experience with conservative non‐dialytic management from the patients' perspective. Design Qualitative study using semi‐structured interviews. Interpretative phenomenological analysis was undertaken as the framework for data analysis. Setting/Participants N ?=?9 ESRD participants who have taken the decision to forego dialysis were recruited from the advanced care programme under the N ational H ealthcare G roup, S ingapore. Results Participants discussed life since ESRD diagnosis, and the personal and contextual factors that led them to choose conservative management. The perceived physical and financial burden of dialysis both for the individual but most importantly for their family, uncertainty over likely gains over risks which were fuelled by communication of negative dialysis stories of others, coupled with sense of life completion and achievement led them to refuse dialysis. All participants took ownership of their decision despite contrary advice by doctors and were content with their decision and current management. Conclusions Study highlights the factors driving patients' decisions for conservative non‐dialytic management over dialysis to allow medical professionals to offer appropriate support to patients through their decision‐making process and in caring them for the rest of their lives.
机译：背景技术透析可以延长患有终末期肾病（ESRD）的人的寿命，但是对于年老且患有多种合并症的患者，透析的负面影响可能会抵消透析的好处。因此，非透析保守治疗已成为另一种治疗途径，但对于患者选择临终治疗的经验知之甚少。目的从患者角度深入了解导致选择退出透析的决策过程，并获得保守的非透析管理经验。使用半结构化访谈设计定性研究。解释性现象学分析被用作数据分析的框架。设置/参与者N i == 9已决定放弃透析的ESRD参与者从新加坡国家健康护理小组的高级护理计划中招募。结果参与者讨论了ESRD诊断以来的生活，以及导致他们选择保守治疗的个人和背景因素。对个人而言，但对家庭而言，最重要的是透析的身体和财务负担，由于他人负面透析故事的传播加剧了对可能获得的收益的不确定性，加上生活的完成感和成就感使他们拒绝接受透析。尽管有医生的相反建议，所有参与者仍对他们的决定拥有所有权，并对他们的决定和当前的管理感到满意。结论研究强调了促使患者做出保守的非透析治疗而不是透析的决定的因素，从而使医疗专业人员可以在决策过程中为患者提供适当的支持，并在他们的余生中给予照顾。

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