2020 Volume 53 Issue 5 Pages 265-270
Patients are frequently forced to make decisions about their treatment plans, leading to conflict between patients, medical teams, and family members. During discussions about the initiation of hemodialysis, some patients with end-stage renal disease are faced with changes and challenges associated with being dialysis patients that cause them to refuse treatment. There is a concern that patients with chronic renal failure might be forced to initiate dialysis against their will, and thereby, suffer worse outcomes and a low quality of life. Therefore, it is worthwhile for clinicians to understand how to support such patients to make decisions. Giving medical advice or persuasion is not only less effective, but can also evoke anxiety or dissatisfaction about treatment. Conversely, activating intrinsic motivation regarding treatment is important because it develops naturally within the individual and not only increases favorable behaviors, but also helps to sustain them for years. Here, we present the case of an elderly patient with renal failure, who refused to start undergoing hemodialysis because of a strong sense of fear based on his prior experience of urgent dialysis. We repeatedly promoted ambivalence concerning his fear and hope regarding the treatment, thereby facilitating intrinsic motivation. As a result, the patient made a commitment to live on dialysis. Motivational interviewing is a communication style that has been shown to be effective at causing behavioral changes in the setting of treating lifestyle-related disease. This is the first reported case in which this psychological intervention was utilized to help a patient who refused to start hemodialysis.
