A qualitative exploration of the factors that influence healthcare decision-making in the management of end stage renal disease in older adults in Ireland.

Background Older patients with end-stage renal disease (ESRD) are willing participants in advance care planning (ACP) but just over 10% engage in it (1-3), potentially as nephrologists fear such conversations may upset patients (4). Hence the values and wishes of patients are frequently underrepresented during key healthcare decision-making (2, 5, 6). Objectives The objective of this thesis is to better understand the care of older patients requiring dialysis in Ireland. First, to explore the approach of nephrologists to managing ESRD in these patients including conservative management, dialysis withdrawal and end of life care. Second, to explore the experience of these patients with dialysis, ACP and their satisfaction with life on dialysis. Methods Both studies utilised qualitative interviews and thematic analyses to distil the data addressing the objectives. Results Twenty nephrologists working in Ireland and fifteen older dialysis patients participated respectively. Nephrologists tend to avoid end of life care discussion reflecting limited communication skills training, a fear of upsetting patients and time constraints. Additional barriers to ACP included limited understanding of ESRD and dialysis by patients. Patients appeared disempowered, displayed limited health literacy and well-being was compromised by limited ACP. Dialysis appeared to jeopardise their core values. Conclusion The participation of nephrologists and older patients with ESRD in ACP and shared decision- making in Ireland is suboptimal. Healthcare decision-making, including dialysis initiation, may not reflect patients’ core values. Enhanced patient education and improved communication skills training for clinicians to facilitate shared decision-making and ACP is recommended.

Publisher

NUI Galway

Rights

Attribution-NonCommercial-NoDerivs 3.0 Ireland
CC BY-NC-ND 3.0 IE

cbn

Collections

University of Galway Theses (PhD Theses)