Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Nephrol Dial Transplant. 2011 Dec;26(12):4038-46. doi: 10.1093/ndt/gfr177. Epub 2011 Apr 11.
Little is known about pre-dialysis patients' or family caregivers' preferences for dialysis modality and the reasons underlying their decisions. The aim of this study was to rank the most important characteristics of dialysis on which patients and caregivers make decisions about treatment.
A mixed methods approach was used with groups of pre-dialysis patients (chronic kidney disease Stage 4/5), dialysis patients and family caregivers. Characteristics of dialysis were identified and ranked individually and then consensus of the most important characteristics was determined within each group. Purposive sampling was used to recruit participants until data saturation was achieved. Transcripts of focus groups were coded and analysed to examine the rationale behind the ranking.
Thirty-four participants from two Australian hospitals attended six 'nominal group' focus groups between September 2009 and February 2010. Two groups involved pre-dialysis patients (total n = 8), two involved peritoneal and haemodialysis patients, respectively (n = 9) and two involved caregivers of dialysis patients (n = 17). We identified 28 characteristics of dialysis important to patients and caregivers. Patient groups agreed that the most important characteristics were (i) survival, (ii) convenience of dialysis at home and (iii) dialysis-free days. For caregivers, the most important were (i) convenience of dialysis at home, (ii) respite and (iii) the ability to travel.
Patients and family caregivers highly value treatment that enhances survival and can be performed at home. Future planning of dialysis services could better reflect these priorities through provision of increased home dialysis support services and planned respite for caregivers.
对于透析模式，透析前患者或其家属的偏好，以及他们决策背后的原因，人们知之甚少。本研究的目的是对患者和护理人员在治疗决策中考虑的透析最重要的特征进行排序。
采用混合方法，对透析前患者（慢性肾脏病 4/5 期）、透析患者和家属护理人员进行分组。分别确定和排序透析的特征，然后在每个组内确定最重要特征的共识。采用目的性抽样招募参与者，直到达到数据饱和。对焦点小组的转录本进行编码和分析，以检查排名背后的基本原理。
2009 年 9 月至 2010 年 2 月期间，澳大利亚两家医院的 34 名参与者参加了六次“名义小组”焦点小组。两组涉及透析前患者（共 8 名），两组分别涉及腹膜和血液透析患者（9 名），两组涉及透析患者的护理人员（17 名）。我们确定了对患者和护理人员重要的 28 种透析特征。患者组一致认为最重要的特征是（i）存活，（ii）在家中进行透析的便利性，以及（iii）无透析日。对于护理人员，最重要的是（i）在家中进行透析的便利性，（ii）休息，以及（iii）旅行的能力。
患者和家庭护理人员非常重视能提高生存率且可在家中进行的治疗。未来的透析服务规划可以通过提供更多的家庭透析支持服务和为护理人员计划休息时间来更好地反映这些优先事项。
