ArticleBMC nephrology2025
'That's why I wanted him to go on dialysis' - a qualitative inductive thematic analysis of older patients' and their family members' perspectives on kidney failure treatment decision-making.
Article in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Global Variation in Predictors of Uptake of Conservative Kidney Management: A Systematic Review and Meta-Analysis.Journal of renal care · 2026Pooled it
- Deciding between conservative kidney management and dialysis in older people with kidney failure: a narrative review.Clinical kidney journal · 2026Review
- How do older patients with advanced kidney disease, and their family members, understand kidney function and failure? A qualitative study.BMC nephrology · 2025Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChronic kidney disease (CKD) is increasingly common amongst frail older patients with multiple health problems. These patients typically decide between kidney replacement therapy (KRT) with dialysis, which carries uncertain survival benefit with significant treatment burden, and conservative kidney management (CKM). A person-centred approach to this shared decision-making process is advocated. Family members are known to be important in these decisions. Nonetheless, data exploring family member perspectives are limited. We aimed to explore how older, frail and/or comorbid patients with CKD and their family members understand and approach decision-making regarding treatments for kidney failure.
methodsSemi-structured interviews were conducted, in person, in 2018-2019, with older patients with advanced CKD (≥ 80 years or ≥ 65 with evidence of frailty or comorbidity) and at least one family member per patient. Interview transcripts were analysed using inductive thematic analysis with constant comparison within and between family units. Meanings and concepts were discussed between study investigators, to generate a coding framework and develop major themes.
resultsTen patients and 12 associated family members were interviewed. Three major themes were identified: (1) "whose decision is it anyway?" concerns ownership of treatment decisions; (2) "on death, dying and uncertain futures" describes relational elements of participants' thoughts of the future; and (3) "caring and being cared for" explores the importance of physical and emotional caring roles and love and care in relationships.
conclusionsFamily members appear to have significant influence on older patients' kidney failure treatment decisions, which can occur outside the shared decision-making support offered to patients. The inextricably intertwined daily lives of co-habiting patients and family members means that treatment decisions impact and depend upon both family members and patients. Kidney services should adopt a 'family-centred' (rather than individually 'person-centred') approach to decision-making support and must develop ways to embed this in clinical practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.