Table 11 Excerpt 10 Mixed messages and less effective local management

21.

Doc6:

So, she–you’re sitting about 10 per cent now, for your kidney function.

22–198 omitted

199.

Doc6:

So, usually when people start reaching your kidney function, about 10 per cent, we start looking at dialysis, really.

200–346 omitted

347.

It’s a possibility that, you know, obviously, she needs time to think about it. But in the meantime, that she might deteriorate in the meantime, and she might come to a situation where she needs an emergency dialysis.

348.

CKD-P8’ Daughter-in-law: (DIL)

Oh, okay.

349.

Doc6:

Yeah, so, it’s – obviously, you know, she’s thinking that she doesn’t want to do it.

350.

CKD-P8’ DIL

Yeah, that’s what the GP told me, that girl one. She’s not happy now to do it, when she will decide if to do it. But I’m - kidney level will be going down and down and that will a more painful for her.

351.

Doc6:

Hm.

352.

CKD-P8’ DIL

So, because she was keep telling me that she has to do dialysis when the kidney level was 16.

353.

Doc6:

Hm.

354.

CKD-P8’ DIL:

But my mother-in-law didn’t make any mind to do it then.

355.

Doc6:

Yeah, and she wouldn’t be the only one. I think a lot of patients find it’s hard to want to – it’s a very big change in life, isn’t it. You know, one day, you’re fine, the next day, you’re cooped up to – hooked up to a machine three days a week or, you know, every day and night. You have to go to more doctor appointments, you get blood tests, I mean, it’s going to be a big change for her. A lot of people do take some time to come to terms with that, especially when they are feeling quite okay. They say, why do I need dialysis? I feel okay.

356.

CKD-P8’s son:

Yeah, at the moment, she’s doing all right.

357.

Doc6:

Yeah. But we do know that this will get worse with time. So, you say, look, let’s just pre-empt it and get all these things planned in advance. Rather than wait for her to be really unwell one day, come to hospital feeling really sick, you know, her unsafe blood tests and things. But I know, it’s obvious to me she has to think about it on her own terms. No-one should force her into it.

358–375 omitted

376.

Doc6:

So, look, for now, I won’t – I don’t want to force you to decisions, I just – my role is to give you an explanation of why we do things for her.

377–627 omitted

628.

Doc6:

But we’ll do a blood test and any trouble, let us know in the meantime.

629.

CKD-P8’ DIL

Yeah. We’ll see if she can make decision soon.

630.

Doc6:

Yeah, I know…

631.

CKD-P8’s DIL

Yeah.

632.

Doc6:

… that it’s not an easy one to do for her and for you guys as well.

633.

CKD-P8’s DIL:

It is. It’s not an easy one to…