Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Nephrol. 2009 Nov-Dec;22(6):794-9.
Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy.
In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis.
All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future.
Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life.
终末期肾病的老年患者必须做出艰难的决定，是否开始透析。本研究探讨了这些患者在决定肾脏替代治疗时所考虑的因素。
通过深入访谈，深入了解治疗决策中的考虑因素。14 名年龄在 65 岁或以上的患者参与了访谈，其中 8 名患者决定开始透析，6 名患者决定不开始透析。
所有参与的患者都有各种各样的健康问题，但似乎认知功能正常。与接受透析的患者相比，拒绝透析的患者年龄更大，更多是男性和鳏夫（寡妇）。患者选择开始透析是因为他们享受生活，不准备面对生命的尽头，觉得别无选择，或者对家庭成员有照顾责任。患者拒绝透析是因为推测会失去自主权，他们因年龄而活力下降，离透析中心远，以及不愿意考虑未来。
结果表明，患者拒绝或接受透析的决定不是基于治疗的效果，而是基于个人的价值观、信仰和对生活、痛苦和死亡的看法，以及将治疗融入生活的预期困难。
