Self-referral of Chinese patients with advanced chronic kidney disease
and treatment decision-making: A qualitative study
Abstract
Abstract: Rationale, aims, and objectives: Chinese patients with
advanced chronic kidney disease (CKD), especially rural patients
possibly occur self-referral behavior and then treatment decisions
followed. It is unclear the relationship between self-referral and
treatment decision-making. Thus, the aim of this study was to explore
the perceptions and views of self-referral and treatment decision making
among patients with advanced chronic kidney disease. Methods: We
conducted semi-structured interviews with 26 patients with advanced
kidney disease and 12 nephrologists. Interviews were conducted and
analyzed thematically until reaching thematic saturation. Results: We
identified three themes reflected: 1) self-referral decision making
(self-referral motive, barrier to self-referral, seeking for
self-referral information); 2) the views and experience of self-referral
care (facilitating shared decision making, imposing psychological
pressure, feeling about self-referral communication, challenge to
staff-patient relationship); 3) treatment decision making (decisional
awareness and roles, cost-benefit trade-off and redicision).
Conclusions: Our study identified that organizational and demographic
factors, self-referral motives worked together at the self-referral
decision-making and treatment decision-making when advanced CKD patients
facing with healthcare facilities and treatment options. Those findings
suggest stakeholders should accelerate the popularization of peritoneal
dialysis technology and establish the CKD screening and management
systems. For self-referral patients with advanced CKD, our results
suggest specialized dialysis transition care to improve quality of
communication and soothe patients’ negative emotion.