Patient decision-making regarding life-sustaining treatment for end-stage renal disease
Mary Lucia Feild, BS, MS, PhD
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Despite growing involvement of patients in treatment decisions for serious illness, little is yet known about the actual process that they use to make such choices. Most decision research has relied on hypothetical decision situations under controlled laboratory conditions to test deductively derived theories. The purpose of this study was to generate a substantive theory that describes the patient decision making process for treatment of End-Stage Renal Disease, a condition that leads to death without dialysis or transplantation.
The study employed a qualitative, longitudinal design using grounded theory methodology. Sixteen persons with declining renal function consented to a total of 33 audiotaped, semi-structured interviews conducted at various points in the decision making process. Data were transcribed verbatim, coded, and analyzed using the constant comparative method. Trustworthiness of the findings was supported by evidence of credibility and dependability.
Pathfinding is the basic psychosocial process that emerged from the data. It is a nonlinear, four-phase process that is dynamic, goal-oriented, recursive, and continually evolving. Each phase, influenced by antecedent conditions, culminates in a critical decision in the process: Phase 1. Striving for Survival: the treatment acceptance decision; Phase 2. Striving for Normalcy: the treatment preference decision; Phase 3. Striving for Readiness: the treatment initiation decision; Phase 4. Striving for Integration: the treatment continuation decision.
Properties of the process vary according to both the nature of the decision and attributes of the decision maker. Three major, interrelated categories of strategies comprise the central action of the model. These categories are Discovering the Meaning of the Decision Situation, Choosing Treatment Direction, and Moving Forward with Choices. They account for progression from one phase to another through mutual interaction with the antecedents of each phase. Influencing conditions include personal, relational, and contextual factors. Decisional satisfaction depends on perceived adequacy of goal attainment in each phase. Consequences of decisional dissatisfaction include resignation, reconsideration, and/or reversal.
This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 9713065; ProQuest document ID: 304303526. The author still retains copyright.
This item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
|Review Type||None: Degree-based Submission|
|Evidence Level||Grounded Theory|
|Research Approach||Qualitative Research|
Treatment Decision Making Process;
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