Renal Dialysis Refusal in End-Stage Renal Disease Patients Under Universal Health Coverage Scheme in Uttaradit Province

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Apiradee Apiwatnakorn
Sasitorn Chaiprasitti


Background and Objective: Almost half of end-state renal disease patients under universal health coverage scheme in Uttaradit  province rejected dialysis despite receiving counseling from the multidisciplinary team from 2015 to 2017, which has been a barrier to treatment. This study aimed to understand patients’ decision making regarding dialysis rejection.

Methods: A qualitative study was then conducted based on semi-structure in-depth interviews with explanatory model and non-participatory observation with 36 ESRD (End-Stage Renal Disease) patients under universal coverage scheme who rejected dialysis in Kidney Disease Center at Uttaradit hospital during January to March 2018. These data were examined using content analysis.

Results: Most patients could not describe chronic kidney disease and dialysis based on biomedical knowledge. However, patients had a model of thinking, definition and the decision to reject dialysis based on their beliefs, experience and individual context. There were five explanatory models, which were; dialysis indicated impending death, dialysis made independent life impossible, dialysis reduced the ability to care for their family, dialysis was a shackle, and dialysis decreased the remaining quality of life.

Conclusion:  Patients’ view, dialysis is not just a treatment but it is liked to living and context with constraints. So the multidisciplinary team should understand, respect the decision of the patients and treat patients holistically.


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