Choosing conservative care in advanced chronic kidney disease: a scoping review of patients’ perspectives

Abstract

Background. Conservative care (CC) is a viable treatment option for some patients with kidney failure. Choosing between dialys and CC can be a complex decision in which involvement of patients is desirable. Gaining insight into the experiences and preferenc of patients regarding this decision-making process is an important initial step to improve care. We aimed to identify what is know about the perspective of patients regarding decision-making when considering CC. Methods. PubMed, EMBASE and Cochrane databases were systematically searched on 23 February 2023 for qualitative and quantitati studies on patient-reported experiences on decision-making about CC. Data were analysed thematically. Results. Twenty articles were included. We identified three major themes: creating awareness about disease and treatment choic decision support and motivation to choose CC. Patients were often not aware of the option to choose CC. Patients felt supported their loved ones during the decision-making process, although they perceived they made the final decision to choose CC themselve Some patients felt pressured by their healthcare professional to choose dialysis. Reported reasons to choose CC were maintainin quality of life, treatment burden of dialysis, cost and the desire not to be a burden to others. In general, patients were satisfied wi their decision for CC. Conclusions. By focussing on the perspective of patients, we identified a wide range of patient experiences and preferences regardin the decision-making process. These findings can help to improve the complex decision-making process between dialysis and CC an to provide patient-centred care.