Why take the chance? A qualitative grounded theory study of nocturnal haemodialysis recipients who decline kidney transplantation

ObjectiveThe objective of this study was to examine the factors that influence decision-making to forgo transplantation in favour of remaining on nocturnal haemodialysis (NHD).DesignA grounded theory approach using in-depth telephone interviewing was used.SettingParticipants were identified from 2 tertiary care renal programmes in Canada.ParticipantsThe study participants were otherwise eligible patients with end-stage renal disease who have opted to remain off of the transplant list. A total of 7 eligible participants were interviewed. 5 were male. The mean age was 46 years.AnalysisA constant comparative method of analysis was used to identify a core category and factors influencing the decision-making process.ResultsIn this grounded theory study of people receiving NHD who refused kidney transplantation, the core category of ‘why take a chance when things are going well?’ was identified, along with 4 factors that influenced the decision including ‘negative past experience’, ‘feeling well on NHD’, ‘gaining autonomy’ and ‘responsibility’.ConclusionsThis study provides insight into patients' thought processes surrounding an important treatment decision. Such insights might help the renal team to better understand, and thereby respect, patient choice in a patient-centred care paradigm. Findings may also be useful in the development of education programmes addressing the specific concerns of this population of patients.