London Health Sciences Centre, Canada; University of Alberta, Canada.
Int J Nurs Stud. 2013 Jan;50(1):109-20. doi: 10.1016/j.ijnurstu.2012.04.003. Epub 2012 May 3.
This systematic review examined how people with chronic kidney disease make decisions about the type of dialysis modality to use. In particular, meta-synthesis was used to understand the process of patient decision-making and how aspects of context influenced these decisions. This topic is important because home-dialysis has economic and quality of life advantages for patients and society but is underutilized. To increase the use of home-based dialysis services a greater understanding is needed of how patients make dialysis modality decisions.
Systematic review methods incorporating meta-synthesis were used.
Seven databases were used for the search. Eligible studies were published qualitative research studies containing extractable data on decision-making about dialysis modality selection generated from patients with chronic kidney disease.
A systematic review was conducted and the data were analyzed using meta-synthesis (also known as meta-ethnography) for qualitative research.
Sixteen studies were included (410 patients at various stages of chronic kidney disease). Across all the studies, decisions drew on patients' values and in the context of their situation and life. Common elements across patients' decisions were: (1) the illusion of choice--a matter of life or death, (2) minimization of the intrusiveness of dialysis on quality of life, autonomy, values, sense of self, and (3) decision-making in the context of wider knowledge and support.
Modality decisions are highly personal and strongly influenced by patient and family values, the context of their life, and a desire for minimal intrusiveness. There is a clear need for planned and timely discussions about modalities in which home-based dialysis is presented as a viable option. Professional support should focus on patient and family preparation, knowledge of different modalities and the lifestyle implications of different modality choices.
本系统评价研究了慢性肾脏病患者如何做出透析方式选择的决策。特别采用元综合方法来理解患者决策过程以及环境因素如何影响这些决策。这一主题很重要，因为家庭透析对患者和社会具有经济和生活质量优势，但利用率较低。为了增加家庭透析服务的使用，需要更深入地了解患者如何做出透析方式决策。
采用系统评价方法，纳入元综合。
使用 7 个数据库进行检索。合格研究为发表的定性研究，包含从慢性肾脏病患者中提取的关于透析方式选择决策的可提取数据。
进行系统评价，采用元综合（也称为元民族志学）对定性研究进行数据分析。
纳入 16 项研究（410 名处于慢性肾脏病不同阶段的患者）。所有研究中，决策都基于患者的价值观，并考虑到他们的情况和生活。患者决策的共同要素包括：（1）选择的幻觉——生死攸关；（2）将透析对生活质量、自主性、价值观、自我意识的侵入性最小化；（3）在更广泛的知识和支持背景下做出决策。
方式决策具有高度的个体性，深受患者及其家庭价值观、生活背景以及对最小侵入性的渴望的影响。显然需要有计划地及时讨论家庭透析作为可行选择的方式。专业支持应侧重于患者和家庭的准备、对不同方式的了解以及不同方式选择对生活方式的影响。
