Exploring Willingness: What Drives Dialysis Withdrawal Decisions in Patients With End-stage Renal Disease? A Cross-sectional Study.
Cheng-Pei Lin, Jung-Chi Lee, Chi-Feng Pan and 1 others
PMID 40550002WHAT IT FOUND
Willingness to withdraw from dialysis rose as hypothetical prognosis worsened, but more than half of 121 hemodialysis patients still preferred to continue.
Poor dialysis quality, junior high school education, and better palliative care knowledge were linked to withdrawal willingness.
Key findings
01Willingness to withdraw from dialysis increased with disease-related deterioration, but more than half still preferred to continue dialysis, with the proportion decreasing from 76% to 53.7%.
02Educational level, dialysis quality, symptom severity, symptom interference, and palliative care knowledge were associated with willingness in all three prognosis scenarios; educational level, dialysis quality, and palliative care knowledge were influential factors, explaining 19% to 34% of willingness.
03Nephrologists were identified as wielding the most influence on patient withdrawal decisions (66.41%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Convenience sampling of 121 patients from dialysis units in Taiwan limits how far the findings apply to other settings or to patients with peritoneal dialysis, dementia, psychiatric disorders, impaired mental capacity, or communication difficulties. The study was cross-sectional and asked patients about hypothetical prognosis scenarios, so it cannot show how willingness actually changes over time or what patients would choose when facing real deterioration. The statistical models explained 19% to 34% of willingness, so education, dialysis quality, symptoms, and palliative care knowledge are associated factors, not proven causes. Health behaviours and health care provider perspectives were not collected, so other influences on decisions may have been missed. All participants were hemodialysis patients, and willingness was measured with self-report questionnaires and a palliative care knowledge scale developed by the authors.
Declared interests
Mackay Memorial Hospital funded the study. No author conflict-of-interest declarations are reported in the supplied text.
The easy way to misread this
Do not conclude that poor dialysis quality, junior high school education, or better palliative care knowledge caused patients to want to withdraw from dialysis. This was a cross-sectional survey of 121 patients using hypothetical prognosis scenarios. The models explained 19% to 34% of willingness, and more than half still preferred to continue dialysis.