Lin Cheng-Pei, Lee Jung-Chi, Pan Chi-Feng, Chen Yu-Chi
Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
J Nurs Res. 2025 Jun 24. doi: 10.1097/jnr.0000000000000684.
Withdrawal from dialysis in patients with end-stage renal disease (ESRD) can mitigate futile treatments and facilitate early end-of-life care preparation. However, the reasons patients willingly withdraw from elective dialysis under varying disease prognoses, and the factors that influence these decisions, remain unclear.
To explore the factors influencing the willingness to electively withdraw from dialysis in patients with ESRD at different disease prognoses.
This cross-sectional observational study was conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Using convenience sampling, patients aged ≥ 45 who had regularly undergone hemodialysis for more than 6 months were recruited from a medical center and a local clinic. We used structured questionnaires and chart reviews to collect data from February to April 2021. Descriptive analysis, Pearson's correlations, and stepwise regression were employed to assess willingness to electively withdraw from dialysis.
The 121 participants enrolled were of an average age of 61.09 years, had undergone dialysis for 7 years, and had a median of four comorbidities. Willingness to withdraw from dialysis increased as their disease worsened. However, more than half preferred to continue dialysis, with the number of patients decreasing from 76% to 53.7% across the disease deterioration trajectory. The participants identified nephrologists as the most influential individuals in their dialysis withdrawal discussions. Factors associated with dialysis withdrawal decisions across all hypothetical prognosis scenarios (current disease conditions, irreversible complications, and estimated survival < 6 mo) included poor quality of dialysis, lower educational level (junior high school), and better knowledge of palliative care.
CONCLUSIONS/IMPLICATIONS FOR FUTURE PRACTICE: Willingness to withdraw from dialysis is associated with dialysis quality, educational level, and palliative care knowledge under different hypothetical prognosis scenarios. Nephrologists play a pivotal role in initiating withdrawal discussions and influencing decision-making. Health care providers should consider these factors during routine renal nursing care and identify the appropriate time to initiate advanced care planning discussions. Regular monitoring of dialysis-related symptoms and quality (measured by Kt/V) and evaluating patients' understanding of palliative care are both essential in ESRD care. As primary caregivers, nurses play a crucial role in integrating these assessments into routine care to identify patients considering dialysis withdrawal. Collaborative efforts between nurses and nephrologists are vital to initiate timely end-of-life care discussions and preparations, improve patient-centered care, and improve end-of-life outcomes in ESRD management.
终末期肾病（ESRD）患者停止透析可减少无效治疗，并有助于早期进行临终护理准备。然而，在不同疾病预后情况下患者自愿停止选择性透析的原因以及影响这些决定的因素仍不明确。
探讨不同疾病预后情况下影响ESRD患者自愿停止透析意愿的因素。
本横断面观察性研究按照加强流行病学观察性研究报告（STROBE）指南进行。采用便利抽样法，从一家医疗中心和一家当地诊所招募年龄≥45岁、规律进行血液透析超过6个月的患者。我们使用结构化问卷和病历审查从2021年2月至4月收集数据。采用描述性分析、Pearson相关性分析和逐步回归分析来评估自愿停止透析的意愿。
纳入的121名参与者平均年龄为61.09岁，透析时间为7年，合并症中位数为4种。随着疾病恶化，停止透析的意愿增加。然而，超过一半的人更倾向于继续透析，在疾病恶化过程中，这一比例从76%降至53.7%。参与者认为肾病科医生在他们关于停止透析的讨论中是最有影响力的人。在所有假设预后情况（当前疾病状况、不可逆并发症和估计生存期<6个月）下，与停止透析决定相关的因素包括透析质量差、教育水平较低（初中）以及对姑息治疗的了解较多。
结论/对未来实践的启示：在不同假设预后情况下，停止透析的意愿与透析质量、教育水平和姑息治疗知识相关。肾病科医生在启动停止透析的讨论和影响决策方面起着关键作用。医疗保健提供者在常规肾脏护理过程中应考虑这些因素，并确定启动高级护理计划讨论的合适时机。定期监测透析相关症状和质量（通过Kt/V衡量）以及评估患者对姑息治疗的理解在ESRD护理中都至关重要。作为主要护理人员，护士在将这些评估纳入常规护理以识别考虑停止透析的患者方面起着关键作用。护士和肾病科医生之间的协作努力对于及时启动临终护理讨论和准备、改善以患者为中心的护理以及改善ESRD管理中的临终结局至关重要。
