Decisional Conflicts in Kidney Replacement Therapy for Patients With Grade 5 Chronic Kidney Disease: A Qualitative Meta-Synthesis.
Yao Xu, Yujuan Zheng, Zhiqiao Long and 1 others
PMID 41134045WHAT IT FOUND
Patients choosing kidney replacement therapy often felt afraid, uncertain, poorly informed, and pushed by family or doctors.
Ask about these conflicts before deciding, and support choices with clear, timely information.
Key findings
01Patients with advanced chronic kidney disease often experienced conflict when choosing kidney replacement therapy, driven by fear, uncertainty, limited knowledge, and low willingness to decide.
02Information problems were central: patients lacked clear knowledge, forgot information, encountered overload, and misunderstood what different treatments meant.
03Family and professional support could both help and hinder decisions, because relatives sometimes overrode patient wishes or patients hid their condition, and follow-up support was often missing.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review combined qualitative studies from different countries and settings, so patients' experiences may not match every local dialysis culture. Most included studies were rated only as meeting some quality standards, not all. The authors noted that their own backgrounds and assumptions may have shaped the themes toward a Chinese perspective. The review describes decisional conflicts but does not test whether any communication, education, or decision-support strategy reduces them. Some included studies involved family members or healthcare professionals alongside patients, so the themes may not reflect patients alone.
Declared interests
A provincial health research programme in Zhejiang, China funded the work, and the authors declared no conflicts of interest.
The easy way to misread this
Do not read these themes as proof that communication training or decision aids reduce conflict. The review summarises patients' experiences and does not test an intervention.