Table 3 Older patients’ reasons for their treatment choice. Categorisation of open text responses to the question: “Why did you choose to start or withhold dialysis?”
Choice for dialysis (n = 66) | Examples of answers |
|---|---|
Lack of choice (n = 28) | “Because I have to.” |
Dialysis perceived as unavoidable | “What has to be done has to be done.” |
Seeing no alternatives | “[I have] no other choice.” |
Rejecting conservative care as option | “It [dialysis] was just necessary; withholding is no option.” |
Not eligible for other treatment options | “I won’t receive a new kidney; I just have to [start dialysis], that’s just the way it is.” |
Life prolongation (n = 20) | “[I] want to live longer.” |
Doing everything to prolong life | “Withholding [dialysis] was no option, I still did not feel tired of life.” |
Enjoying life | “[I am] far from finished being on this planet.” |
Social consideration | “I just have to [start dialysis] for my partner and daughter.” |
To be longer with family | “[I] want to live on, [I have] a lot of family.” |
To take care of ill partner | “[My] husband has Alzheimer’s disease, [I] want to be there for him.” |
Following advice of doctor (n = 10) | “On the nephrologist’s advice.” |
To maintain or improve quality of life or symptoms (n = 6) | “[My] physical condition deteriorated, [I] wanted to remain active with table tennis.” |
Reconsidering or doubting choice (n = 6) | “I sometimes think: should I really do it [dialysis]? Age 77 years. I consider to withhold dialysis.” |
Choice for conservative care (n = 21) | |
High treatment burden of dialysis, particularly in-centre (n = 14) | “[Dialysis means] too much hospital.” |
Too much impact on quality of life | “No time to live normally any longer [with dialysis].” |
Loss of autonomy | “I felt reluctant to live with dialysis. [I] still am an active woman, don’t want to be constrained.” |
Physical burden of dialysis | “Potential side-effects of dialysis treatment.” |
Feeling well without dialysis | “I still feel well, not ill.” |
Not eligible for or fearing burden of home dialysis | “No option to go for home dialysis; home dialysis is probably disappointing.” |
High age and sense of life completion (n = 11) | “[I] did not want it [dialysis], age of 84 years. [I] always thought: a human being should be allowed to just die!” |
Unlikely survival benefit of dialysis (n = 3) | “No difference in life expectancy with or without dialysis.” |
Poor health (n = 2) | “[My] health condition.” |
Stories of other patients (n = 2) | “[A] visit to the dialysis unit and talking with patients were decisive factors [to choose conservative care].” |
Following advice of doctor (n = 2) | “[My] nephrologist has given negative advice [to start dialysis].” |