2025 Volume 21 Issue 2 Pages 35-53
Objective：Chronic kidney disease is a significant health problem in Thailand. Advance care planning is recommended for such patients, but it needs to be adjusted for each country’s culture. Thailand still has limited studies on the perspectives of patients and their families on this topic. Therefore, this study aims to clarify the perspective regarding advance care planning of elderly patients with chronic kidney disease receiving dialysis and their family members in a community.
Methods：In this qualitative study, we employed the grounded theory and purposively sampled participants from six health service centers in a community. In-depth interviews and field notes were conducted in a private room, with the data being audiotaped and transcribed verbatim. The analysis was an iterative process, with interviews conducted until theoretical saturation was achieved. Emergent categories were selected by analyzing, discussing, and systematizing the data into core categories and categories, ensuring a comprehensive understanding of the participants’ perspectives.
Results：Twelve patients and their eight family members participated in this study. Three core categories and eleven categories emerged in patients and their family members. Most participants did not discuss their preferred medical treatment and care with health professionals even when they felt near death, and their health professionals did not initiate advance care planning. The normalcy bias and health professionals-participants relationship gap obstructed such discussions. Religious beliefs positively facilitated participants’ perspectives, helped them accept disease conditions, decreased negative emotions, and focused on present health and treatment. Patients and their family members agreed to discuss advance care planning with health professionals and suggested that it should be initiated before patients enter severe illness as individuals with comfortable discussions, held on a nontreatment day at the facility where patients’ convenience, invite family members to participate, provide needed information, and assess patients’ readiness before discussing.
Conclusion：Future studies should clarify normalcy bias among patients and their family members and explore the perspective of health professionals. Relationships between health professionals, patients, and their family members should be established, and religious beliefs should be discussed to facilitate conversation. Participants’ suggestions should be applied to developing advance care planning interventions that respond to their needs.
