Abstract

The aim of the study was to explore the reasons End Stage Renal Disease (ESRD) patients and caregivers withdraw from hemodialysis in South Taiwan. Semi-structured interviews were conducted with three patients and three caregivers individually, and analyzed by a content analysis method.

The study found patients and caregivers each had five different concerns influencing the decision to withdraw from hemodialysis. For the patients, these were as: (1) Patients would like to continue hemodialysis, but trust their doctor's judgment in recommending the treatment be discontinued. (2) Physical deterioration (3) Lack of access to hemodialysis (4) The burden on the family (5) Lack of value or dignity in their lives. Caregivers' concerns were: (1) Self-criticism and self-blame for giving up on patients (2) Respect for patients' own decisions (3) The economic burden on the family (4) The suffering caused to the patient by disease progression (5) Respect for the opinions of medical professionals. The findings suggest that ESRD patients and caregivers have quite different reasons for withdrawing from hemodialysis. Advance care planning should provide clear information about disease progress and medical treatment options, and help ESRD patients and caregivers openly express their anxieties and opinions, empathizing with one another while making decisions for end of life care.

In conclusion, the study has revealed a range of concerns from hemodialysis patients and caregivers. As medical professionals, we should initiate discussion on advance care planning to help patients and caregivers clarify their ideas and reach informed agreement on the decision to withdraw from hemodialysis.