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Abstract: TH-PO773

Dialysis Regret Among Patients Receiving Dialysis: A Qualitative Study

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Dahl, Spencer, University of Rochester Medical Center, Rochester, New York, United States
  • Comrie, Cameron E., Harvard Medical School, Boston, Massachusetts, United States
  • Jawed, Areeba, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Kazi, Basil S., University of Rochester Medical Center, Rochester, New York, United States
  • Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States
Background

Dialysis regret is common among people receiving maintenance dialysis; however, there is a lack in depth patient perspectives explaining the underlying reasons.

Methods

We conducted semi-structured interviews with 32 patients receiving maintenance dialysis, 22 hospitalized and 10 outpatients. To initiate discussion on regret, we asked “do you have any regrets about starting dialysis.” Transcripts were analyzed with MaxQDA software using thematic analysis and assessed for concordance among the research team until thematic saturation was achieved. Among transcripts classified as 'high regret,' we studied other potential explanations for dissatisfaction with dialysis within the same transcript.

Results

In this sample, the mean age of patients was 61.5 (SD ±15), years, 40% had attained less than a high school level education, and 60% earned annual income <$20,000 a year. Three prominent themes related to decisional regret emerged: 1) Poor Dialysis Education: We found that patients expressing dialysis regret reported lack of understanding of their disease and dialysis treatment. Patients described feeling frustrated, embarrassed and apathetic due to their lack of understanding of their condition. 2) Medical paternalism: Medical paternalism appears to also be a key factor in decisional regret – patients frequently expressed that they felt that dialysis initiation was a choice made for them rather than by them with no sense of agency during this process. 3) Expression of Feelings of Regret: The majority of patients had not communicated their feeling of regret to their physician and did not feel they could.

Conclusion

The majority of patients experiencing dialysis regret reported a lack of education on dialysis care and a presence of medical paternalism. Few patients were willing to discuss their regret with their physician. Future shared decision making interventions are needed to examine their effect on regret.