A Qualitative Study On The Cognition And Attitude Of Patients With End-stage Renal Disease And Their Families

Background:Patients with end-stage renal disease mainly rely on renal replacement therapy and kidney transplantation.Most of them rely on hemodialysis to maintain their lives,but their quality of life is low.And as the number of dialysis increases,elderly patients will experience a series of painful psychological and physical conditions.Patients with end-stage renal disease also have a high disease burden,and the mortality rate exceeds that of age-matched cancer and cardiovascular patients.Despite this,many patients do not talk to relatives or clinicians about end-of-life issues,such as whether to receive intensive care unit treatment,referral to palliative care services,withdraw from renal replacement therapy,preparations for resuscitation,or where they may choose to die.Advance care planning can help solve the above dilemmas,and a living will can clarify the treatment needs of patients at the end of life,and help patients achieve autonomy and death with dignity.Since there are few domestic studies devoted to this patient population,this study aims to explore the feasibility of living will in patients with end-stage renal disease,clarify the influencing factors,and provide a reference for the content of tranquil treatment and nursing services.Objective:Explore the feasibility of living will in patients with end-stage renal disease;understand the current status of the participation of family members of patients with end-stage renal disease in the end-stage decision-making of patients;explore the hindering factors that affect the promotion of living will in patients with end-stage renal disease;Provide reference for the future practice of palliative care in ESRD patients.Methods:Use the phenomenological method in the qualitative research to interview patients with end-stage renal disease and family caregivers who have been accompanied by long-term treatment in Shiyan City and Suizhou City from June to November 2019.The interview data is finally saturated Interviewed 15 patients with end-stage renal disease and 12 family members.Use the Colaizzi analysis method to sort out and analyze the interview data.Purpose sampling method and maximum difference method are used to select interview subjects.Results:1.End-stage renal disease patients’ cognition of living wills: insufficient knowledge of living wills,idealization of the content of living wills,innovative implementation methods of living wills,talk about the possibility of secondary harm to the patient during the living will;attitude towards the implementation of the living will:the positive significance of the implementation of the living will,the implementation of the living will is affected by many factors,the uncertainty of the implementation of the living will.2.Family members of ESRD patients have extracted three themes:recognition of living wills,there is still resistance to implementation;obstacles to the promotion of living wills,including family,public opinion,cognition,etc.;the prerequisites and conditions for the implementation of living wills,including laws and regulations,Information support for medical staff,etc.Conclusions:1.ESRD patients do not have sufficient knowledge of living wills,but most patients believe that the implementation of living wills is of positive significance and there are many challenges.The awareness of ESRD patients on living wills should be improved,and patients should be promoted to participate in the end-of-life conversation led by medical staff.2.The family members of ESRD patients lack knowledge of living wills,and should strengthen the publicity of living wills,conduct death education-related lectures in a timely manner,change their negative attitudes towards living wills,and help them establish a correct understanding of living wills.Make the best choice for the patient.