Life Prolonging Choices in Renal Failure: A Qualitative Study Focusing on Chinese American Patients

Outcomes 1. Understand factors influencing patients' decision processes regarding life prolonging treatment of dialysis. 2. Explore opportunities for palliative care intervention within other disciplines of medicine to improve patient care and understanding of choices. Key Message We found similarities in all study participants in their decision to extend life using dialysis regardless of cultural background. Exception to this included the use of TCM to delay dialysis. All participants didn't think they had choices when starting or continuing dialysis. It appears patients and clinicians rely on clinical data (numbers, laboratory values) to make decision to start dialysis.Abstract: Background: Kidney Disease Improving Global Outcomes guidelines emphasize a shared decision-making process to prepare for kidney failure yet make no recommendations about the influence of culture on these processes. [1] The paucity of evidence about Chinese patients' decision process motivated this qualitative research to gain understanding about thought processes influencing Chinese Americans' decision to start dialysis. Methods Semi-structured interviews of 27 adults (13 English speaking, 14 Chinese speaking) receiving dialysis at Tufts Medical Center located in Boston's Chinatown were conducted in English, Cantonese, and Mandarin using an interviewer guide during a respondent's dialysis session. Interviews were audiotaped, translated if required, transcribed, and analyzed using thematic content analysis and modified grounded theory. Results Two major themes emerged from both group 1) decision motivation: respondents seemed to acquiesce to their nephrologist and discussed death as the only alternative; 2) making decisions based on numbers, i.e., results of laboratory tests and their stage of kidney disease. Additionally, Chinese speaking respondents reported using Traditional Chinese Medicine (TCM) to extend the time until dialysis was needed. Along with themes of the content, the interview process provided unique information including many respondents supplied short answers, some were reluctant to answer, and we identified unclear responses. Conclusion Our qualitative study found similarities in all study participants in their decision to extend life using dialysis regardless of cultural background. Exception to this included the use of TCM as a tool to delay dialysis. Regardless of cultural origin, participants did not think they had choices when starting or continuing dialysis. It appears patients and clinicians rely on clinical data (numbers, laboratory values) to make decision to start dialysis. Postponing the start of dialysis appears to include time spent employing alternative treatments such TCM. Keywords Shared Decision Making / Advance Care Planning / Communication