Facilitating advance care planning for patients with end-stage renal disease: the patient perspective.
نویسنده
چکیده
Comprehensive care of patients with ESRD requires expertise in advance care planning (ACP), including attention to ethical, psychosocial, and spiritual issues related to starting, continuing, withholding, and stopping dialysis. However, there are no standards of care regarding when to initiate or how to facilitate ACP. The purpose of this study was to determine the perspectives of patients with ESRD of the salient elements of ACP discussions. An ethnographic, qualitative, in-depth interview study was conducted of outpatients of a university-affiliated nephrology program. Twenty-four patients with ESRD were purposively selected from the renal insufficiency, hemodialysis, and peritoneal dialysis clinics. Establishing patient "buy-in" by identifying perceived benefits of ACP along with acknowledging patients' sense of personal empowerment were critical both for the effective framing of facilitated ACP and for determining patients' ability to participate in facilitated ACP. Patients required more information and earlier initiation of ACP discussions. Information needed to focus more on the individual and how his or her illness and interventions would affect his or her life and relationships and what he or she values most. Empathetic listening also was viewed as an integral component of facilitated ACP. Physicians clearly were seen as having the responsibility for initiating and guiding ACP. The role of patients and family within ACP is complex and varies significantly between patients. For most, family was an integral component of ACP, and many relied extensively on family to make end-of-life decisions. These findings identify a precarious tension between patients' preferences in terms of facilitated ACP and current clinical practice.
منابع مشابه
Hope and advance care planning in patients with end stage renal disease: qualitative interview study.
OBJECTIVE To understand hope in the context of advance care planning from the perspective of patients with end stage renal disease. DESIGN Qualitative in-depth interview study. SETTING Outpatient department of a university affiliated nephrology programme. PARTICIPANTS 19 patients with end stage renal disease purposively selected from the renal insufficiency, haemodialysis, and peritoneal ...
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ورودعنوان ژورنال:
- Clinical journal of the American Society of Nephrology : CJASN
دوره 1 5 شماره
صفحات -
تاریخ انتشار 2006