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Kidney Week

Abstract: PO1367

Factors Contributing to Decisional Conflict in Older Persons Facing Dialysis Decisions

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology


  • Phan, Tramanh, University of Rochester, Rochester, New York, United States
  • Sabescumar, Janany Jansy, University of Rochester, Rochester, New York, United States
  • Norton, Sally, University of Rochester, Rochester, New York, United States
  • Saeed, Fahad, University of Rochester, Rochester, New York, United States

Dialysis and conservative kidney management are the two main treatment options for elderly persons with end-stage-kidney disease who are ineligible for kidney transplantation. The high stakes of these decisions often force patients to choose between quality versus quantity of life. Thus, they face tremendous conflict while making dialysis decisions. This decisional conflict can adversely affect their mental health-related quality of life and leads to avoidable delays in decision making. Exploring factors contributing to dialysis decisional conflict in older persons with chronic kidney disease is critical.


Using a qualitative descriptive approach, we purposefully sampled a cohort of 10 patients; 5 with high scores on decisional conflict scale, and 5 with low scores. Patients met with a palliative care physician to discuss dialysis and these visits were audio-recorded. Audio recordings were transcribed verbatim and entered into MAXQDA for data management. Following an iterative process, 2 independent reviewers analyzed the transcripts for common themes contributing to decisional conflict.


The mean age of patients was 83 years.We observed 3 themes in the data of patients with low decisional conflict: (1) clarity in values, (2) good current quality of life, and (3) strong therapeutic alliance with their nephrologist. In the high decisional conflict group, we observed 5 themes: (1) fear of: physical pain, complications from dialysis and its time commitment, loneliness, and losing independence, (2) concerns about being a burden to loved ones, (3) uncertainty about prognosis, (4) worries about transportation to and from dialysis, and (5) poor knowledge of treatment options.


Patients with high decisional conflict worried about their future quality of life, sense of burdensomeness, prognostic uncertainty, and issues related to transportation. They wished for detailed knowledge of treatment options. Future dialysis decision-making interventions should be tailored to identify each patient’s unique needs, and incorporate details about treatment options and information about logistics of dialysis. Nephrologists need to discuss the expected quality of life and prognosis. Last, family involvement in these discussions and buy-in for or against dialysis may be helpful in mitigating the patient’s sense of being a burden on their loved ones.