The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies
Top Cited Papers
Open Access
- 19 January 2010
- Vol. 340 (jan19 2), c112
- https://doi.org/10.1136/bmj.c112
Abstract
Objective To synthesise the views of patients and carers in decision making regarding treatment for chronic kidney disease, and to determine which factors influence those decisions.Design Systematic review of qualitative studies of decision making and choice for dialysis, transplantation, or palliative care, and thematic synthesis of qualitative studies.Data sources Medline, PsycINFO, CINAHL, Embase, social work abstracts, and digital theses (database inception to week 3 October 2008) to identify literature using qualitative methods (focus groups, interviews, or case studies).Review methods Thematic synthesis involved line by line coding of the findings of the primary studies and development of descriptive and analytical themes.Results 18 studies that reported the experiences of 375 patients and 87 carers were included. 14 studies focused on preferences for dialysis modality, three on transplantation, and one on palliative management. Four major themes were identified as being central to treatment choices: confronting mortality (choosing life 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 influenced the decision making of patients and carers. The problematic timing of information about treatment options and synchronous creation of vascular access seemed to predetermine haemodialysis and inhibit choice of other treatments, including palliative care. A preference to maintain the status quo may explain why patients often remain on their initial therapy.This publication has 34 references indexed in Scilit:
- Methods for the thematic synthesis of qualitative research in systematic reviewsBMC Medical Research Methodology, 2008
- Patients' views regarding choice of dialysis modalityNephrology Dialysis Transplantation, 2008
- Experience of Hong Kong patients awaiting kidney transplantation in mainland ChinaJournal of Clinical Nursing, 2007
- From Synthesis to Script: Transforming Qualitative Research Findings for Use in PracticeQualitative Health Research, 2006
- Disparities in Solid Organ Transplantation for Ethnic Minorities: Facts and SolutionsAmerican Journal of Transplantation, 2006
- The Phenomenology of Deciding About Hemodialysis Among TaiwaneseWestern Journal of Nursing Research, 2005
- Preferences, Knowledge, Communication and Patient-Physician Discussion of Living Kidney Transplantation in African American FamiliesAmerican Journal of Transplantation, 2005
- Use of Focus Groups to Identify Concerns about DialysisMedical Decision Making, 1999
- What If Socioeconomics Made No Difference?Medical Care, 1998
- Minimum Data Needed on Patient Preferences for Accurate, Efficient Medical Decision MakingMedical Care, 1995