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.
Keywords: Self-referral, Decision-making, Advanced chronic
kidney disease, Qualitative research