End-of-life care decisions for haemodialysis patients – ‘We only tend to have that discussion with them when they start deteriorating’

Lazenby, Sophia, Edwards, Adrian G. ORCID: https://orcid.org/0000-0002-6228-4446, Samuriwo, Raymond ORCID: https://orcid.org/0000-0001-5954-0501, Riley, Stephen George, Murray, Mary Ann and Carson-Stevens, Andrew ORCID: https://orcid.org/0000-0002-7580-7699 2017. End-of-life care decisions for haemodialysis patients – ‘We only tend to have that discussion with them when they start deteriorating’. Health Expectations 20 (2) , pp. 260-273. 10.1111/hex.12454

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Abstract

Background Haemodialysis patients receive very little involvement in their end-of-life care decisions. Issues relating to death and dying are commonly avoided until late in their illness. This study aimed to explore the experiences and perceptions of doctors and nurses in nephrology for involving haemodialysis patients in end-of-life care decisions. Methods A semi-structured qualitative interview study with 15 doctors and five nurses and thematic analysis of their accounts was conducted. The setting was a large teaching hospital in Wales, UK. Results Prognosis is not routinely discussed with patients, in part due to a difficulty in estimation and the belief that patients do not want or need this information. Advance care planning is rarely carried out, and end-of-life care discussions are seldom initiated prior to patient deterioration. There is variability in end-of-life practices amongst nephrologists; some patients are felt to be withdrawn from dialysis too late. Furthermore, the possibility and implications of withdrawal are not commonly discussed with well patients. Critical barriers hindering better end-of-life care involvement for these patients are outlined. Conclusions The study provides insights into the complexity of end-of-life conversations and the barriers to achieving better end-of-life communication practices. The results identify opportunities for improving the lives and deaths of haemodialysis patients.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General)
Uncontrolled Keywords:	advance care planning; decision making; end of life; haemodialysis; nephrologists; prognosis
Additional Information:	Article first published online: 10 MAR 2016 This is an open access article under the terms of the Creative Commons Attribution License
Publisher:	Wiley
ISSN:	1369-6513
Date of First Compliant Deposit:	30 March 2016
Date of Acceptance:	10 February 2016
Last Modified:	18 Aug 2023 19:33
URI:	https://orca.cardiff.ac.uk/id/eprint/87987

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