Developing a conceptual model of older patients’ decision‐making process in choosing dialysis or conservative care using meta‐ethnography

Abstract

Aims To systematically review and synthesize qualitative evidence related to decision-making for treatment modalities among older adults with end-stage renal disease. Design A meta-synthesis of the qualitative research was conducted. Data sources A comprehensive literature review using PubMed, CINAHL, PsycINFO, Embase, Web of Sciences and Cochrane was systematically conducted. Qualitative studies published in English from January 2010 to October 2020 were considered. Review methods Qualitative studies were systematically identified and critically appraised. Data synthesis was performed independently by two reviewers. This review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. Results Seven qualitative studies, with publication years ranging from 2015 to 2019, were included in the analysis. Overall, the review comprised studies with a total of 133 participants aged between 61 and 93 years. Through meta-synthesis, three themes were identified: ‘reflecting on treatment options’, ‘confronting difficult decisions’ and ‘maintaining hope in everyday life’. Conclusion Our findings reflect that older adults have varying preferences for treatment options. These preferences are influenced by various factors such as considering the possibility of opting for dialysis and the practical applicability of treatment options. The synthesized conceptual model serves as the first step towards the conceptualization of the treatment-related decision-making process facilitated by adequate communication, in which patients should be encouraged to speak up, and healthcare providers should listen actively to their patients. This review can provide a strategy for providers to communicate treatment options with older patients with ESRD. Impact Healthcare providers should be sensitive to older adults’ preferences, priorities and treatment goals related to worrying about burdening their families and their outlook on life before deciding treatment modality. Our findings highlight that shared decision-making should be tailored to each of the older patients to provide comprehensive and individualized patient-centred care.