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NDT Advance Access originally published online on June 27, 2008
Nephrology Dialysis Transplantation 2008 23(12):3953-3959; doi:10.1093/ndt/gfn365
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Patients’ views regarding choice of dialysis modality

Anne Lee1, Claire Gudex1, Johan V. Povlsen2, Birgitte Bonnevie3 and Camilla P. Nielsen3

1 Centre for Applied Health Services Research and Technology Assessment (CAST), University of Southern Denmark 2 Department for Renal Medicine C, Aarhus University Hospital, Skejby, Aarhus 3 National Board of Health, Danish Centre for Evaluation and Health Technology Assessment, Denmark

Correspondence and offprint requests to: Anne Lee, Centre for Applied Health Services Research and Technology Assessment (CAST), University of Southern Denmark, J.B. Winsloews Vej 9B, 1st floor, DK-5000 Odense C, Denmark. Tel: +45-6550-3086; Fax: +45-6550-3281; E-mail: ale{at}cast.sdu.dk



  Abstract

Background. Increasing patient numbers have resulted in pressure on dialysis centres and a need to reorganize dialysis treatment. This study explored patients’ experiences with different dialysis modalities and investigated issues related to the patient's choice of modality, especially ‘out-of-centre’ dialysis (i.e. modalities other than CHD).

Methods. Six focus group interviews were conducted with 24 dialysis patients, 3 pre-dialysis patients and 18 relatives. Each focus group comprised patients on one type of dialysis, i.e. CHD, self-care CHD, HHD, CAPD/APD, aAPD or pre-dialysis patients. Based on a semi-structured interview guide, the group discussions centred on advantages and disadvantages of dialysis modalities, problems experienced and their (possible) solutions and patient involvement in choice of modality.

Results. The focus groups participants considered that each dialysis modality has its advantages and disadvantages. Flexibility, independence and feelings of security were key factors in determining choice of modality, with maintenance of a normal life being a major goal. Patients and their relatives want to participate in choice of modality, but a genuine offer of out-of-centre dialysis including professional support and appropriate and timely education is needed to encourage a greater use of modalities other than CHD.

Conclusions. No single dialysis modality emerged as offering the best solution for patients with end-stage renal disease. In the absence of absolute clinical contraindications, the treatment of choice should be the modality that best accommodates the patients’ preferences for their daily activities and lifestyle. A move towards more patients on out-of-centre dialysis requires a greater focus on pre-dialysis patients and closer consideration of patients’ preferences and current lifestyle.

Keywords: dialysis; modality; patient views; quality of life; choice

Received for publication: 21. 5.08
Accepted in revised form: 6. 6.08


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