Thought and discussion about stopping dialysis among dialysis patients
People on dialysis are in a unique situation due to their continuous reliance on life-sustaining medical technology. Additionally, dialysis patients frequently have to make crucial decisions about their medical care such as: what treatment modality is best for them (hemodialysis vs. peritoneal dialysis); is kidney transplant an option; and to when forego or withdraw from treatment. In the United States, voluntary withdrawal from dialysis accounts for approximately 17% of all deaths among dialysis patients. However, little is known about how often dialysis patients think about and discuss this issue. The author surveyed eighty-five chronic dialysis patients (76 receiving in-center hemodialysis and 9 receiving peritoneal dialysis) and asked them how often they thought about and discussed stopping dialysis with a family member/caregiver or health care provider. Participants were also asked what, if any, changes in their health status or personal life would cause them to consider stopping dialysis. The survey collected demographic data and assessed the relationships among locus of control, social support, spirituality, subjective health status and how often dialysis patients thought about and discussed stopping dialysis. Participants, in the present study, responded in one of three ways regarding thought and discussion about stopping dialysis: Group (1) participants reported that they had never thought about stopping dialysis (32%); Group (2) participants had thought about stopping dialysis rarely or sometimes but never or rarely discussed it with a family member/care giver or health care provider (32%); and Group (3) participants had thought about and discussed stopping dialysis with a family member/care giver or health care provider at least some of the time (36%). Those participants who thought about and discussed stopping dialysis at least some of the time reported significantly greater role limitations due to physical health problems, role limitations due to emotional problems, less energy, and poorer general health than both those participants who thought about stopping dialysis but never or rarely discussed it and those participants who never thought about stopping dialysis. Men who thought about and discussed stopping dialysis reported greater loss of physical ability and less energy than women who thought about and discussed stopping dialysis. When asked about changes in health status that would cause one to consider stopping dialysis, the majority of participants stated “an inability to care for oneself.” A greater understanding of patients' preferences regarding withdrawal from dialysis may improve end-of-life decision making among the dialysis patient population. A discussion among the patient, family member/caregiver, and renal treatment team regarding withdrawal from dialysis and under what, if any, circumstances the patient would want to discontinue treatment should be held prior to a medical crisis (e.g., coma or stroke).
Gee, Matthew D, "Thought and discussion about stopping dialysis among dialysis patients" (2005). ETD Collection for Fordham University. AAI3162706.