Open AccessEnd‐of‐life care decisions for haemodialysis patients – ‘We only tend to have that discussion with them when they start deteriorating’
Author(s) -
Lazenby Sophia,
Edwards Adrian,
Samuriwo Raymond,
Riley Stephen,
Murray Mary Ann,
CarsonStevens Andrew
Publication year - 2017
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/hex.12454
Subject(s) - end of life care , thematic analysis , advance care planning , medicine , dialysis , qualitative research , nursing , psychology , family medicine , palliative care , psychiatry , social science , sociology
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 There is variability in end‐of‐life practices amongst nephrologists; some patients are felt to be withdrawn from dialysis too late.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.