Dialysis or Death: A Qualitative Study of Older Patients’ and Their Families’ Understanding of Kidney Failure Treatment Options in a US Public Hospital Setting

RATIONALE & OBJECTIVE: Conservative management (medical management without dialysis) may be an appropriate treatment option for some older patients with advanced chronic kidney disease or kidney failure. Patients’ and family members’ perspectives about conservative management in the United States have been relatively unexplored. STUDY DESIGN: Qualitative study with individual semi-structured interviews. SETTING & PARTICIPANTS: We recruited patients 65 years and older and their family members from a public hospital system in the United States. ANALYTICAL APPROACH: Participants were asked about perspectives of kidney failure treatment options. Interviews were audiotaped, transcribed, and analyzed using an iterative approach to thematic analysis. RESULTS: Among 15 patient and 6 family member interviews, we identified 3 themes. Participants: (1) do not view conservative management as a viable personal option for their own (or their family members’) care, (2) understand the realities of dialysis only abstractly, and (3) consider dialysis the only treatment option for kidney failure and any alternative as death. LIMITATIONS: Single site, public hospital setting. Included patients younger than 75 years for whom dialysis likely has survival benefit. Changed the definition of conservative management partway through the study. CONCLUSIONS: Older patients and family lack full understanding of kidney failure treatment options and are therefore unable to make truly informed care decisions.