A Qualitative Study of What Chronic Kidney Disease Patients and Physicians Value during Discussions of Renal Replacement Therapy Options

Abstract

    This study was conducted to determine what chronic kidney disease patients and physicians value in their discussions about the choice of renal replacement therapy, and to obtain suggestions for better discussions from the perspective of the patient. Semistructured interviews were conducted with 10 patients and 10 physicians who discussed the choice of renal replacement therapy. The items that the patients and physicians valued were analyzed using Krippendorff's content analysis method. From the analysis results, “(patient's) autonomy”, “(patient's) individuality”, and “patient-physician relationship” were extracted as the common items valued by the patients and physicians during their discussions. As for differences in the items valued between the patients and the physicians, the patients valued “delaying the introduction of dialysis” in addition to “physician's humanity” and “responsiveness”, whereas the physicians valued “patient's understanding and acceptance of dialysis”, “family participation”, and “environment for discussion”. The results also showed that the patients and physicians have different recognitions and perceptions of the discussion of renal replacement therapy options. Therefore, it is necessary for physicians to identify what patients value in their discussions, not just medical aspects, and also to confirm each other's perspective of the discussion, was indicated.