Decision-making of older dialysis patients: Interviews of patients and families

Background: Nationally, dialysis is terminated prior to death in approximately 25% of end-stage renal disease patients. The rate of withdrawal varies by region; in the Upper Midwest, withdrawal is more common, approaching 50% in some practices. Older patients' decision-making regarding continuation or termination of dialysis has not been examined closely. Methods: We conducted 31 interviews of dialysis patients 70+ years and/or their family members in Northern Wisconsin and Northern Minnesota, examining dialysis experience and decisions to continue or terminate dialysis. Interview transcripts were analyzed using qualitative methods. Results: Three broad themes emerged: (1) Narrowing horizons (“We used to like to go for a ride, say down to Duluth … [now] … I find that it's very nice to be able to go … to the grocery store, we use a cart …”); (2) Take it one day at a time (“We don't control our own lives … any more than we can control the sun coming up in the morning”); and (3) Death, where is thy sting (“I've never been afraid of death, it's gonna happen to everyone, and I don't mind, at 81 years”). Conclusions: These older dialysis patients and their families did not evince anxiety about mortality. We noted a strong current of acceptance, related to dialysis, reduced opportunities, and health and mortality. These patients' acceptance of the burdens of dialysis appeared to be consistent with their acceptance of their prognosis. Future research should examine associations between these attitudes and advancing age, prognosis, and region of the country.