Patients' choice...is it? A qualitative study of patients' perceptions of why, how, and by whom dialysis treatment modality was chosen

Abstract

The purpose of this qualitative study was to elicit patients' perceptions of why, how, and by whom their dialysis treatment modality, hemodialysis or continuous ambulatory peritoneal dialysis (CAPD), was chosen. Data were collected from 22 patients, four to seven from each of the four renal dialysis units affiliated with a 747-bed urban university teaching hospital located in a northeastern city of the United States. Patients were selected from each of the four following types of dialysis units based on type of dialysis treatment modality: (1) Outpatient hemodialysis; (2) Outpatient continuous ambulatory peritoneal dialysis (CAPD); (3) In-hospital hemodialysis; and (4) Self-in-center hemodialysis. Patient selection was determined by collaborating with the nurse managers of the four dialysis units to determine which patients had the ability to articulate their perspectives of decisions and preferences related to dialysis treatment type. Final selection was determined by the patient's willingness to participate. Data were collected by 22 individual focused, semi-structured in-depth interviews, using an interview schedule comprised of six open-ended questions. For these data, a grounded approach was used for analysis and discovery of a grounded theory based on the emergence of themes. The Ethnograph computer software program was used to facilitate coding and data management. The goal of this grounded approach was to develop a theory based on the data. A grounded theory "Patients' Choice of a Treatment Modality versus Patient Selection for a Treatment Modality" was discovered through the analysis of the data provided by the informants. The emergent themes that supported the development of this theory evolved around who was involved in the decision making process: the patient, the family, and/or the health care giver. The themes also evolved around why and how the decision was made.