Original InvestigationSystem-Level Barriers and Facilitators for Foregoing or Withdrawing Dialysis: A Qualitative Study of Nephrologists in the United States and England
Section snippets
Study Design and Conduct
We used a comparative narrative design of nephrologists’ beliefs and practices in the United States and England as related to dialysis decision making.15, 16, 17 We developed an interview guide using practical knowledge of the clinical arena and existing literature, with the intention of capturing the factors influencing nephrologists’ beliefs and practices (Box 1). The University of California, San Francisco Institutional Review Board approved the study (#13-11184).
Participant Selection
One investigator from
Participant Characteristics
A total of 59 interviews were completed among 18 English nephrologists and 41 American nephrologists. The average duration of interviews was 34 (range, 13.5-60) minutes. All interviews with English nephrologists were in person. Ten interviews with American nephrologists were in person, 10 were by videoconference (eg, Skype or FaceTime), and 21 were by speakerphone.
Most participants were 45 years or younger, men, and white (Table 1). Average number of years since completing nephrology training
Discussion
In this study, we found that nephrologists in the United States and England identified several system-level factors that both facilitated and interfered with making decisions around foregoing or withdrawing dialysis therapy. System-level factors emanated from national and institutional policies and structural factors, from how providers practice medicine (the culture of medicine), and from beliefs and behaviors of the lay public. By virtue of its qualitative design, this study extends knowledge
Acknowledgements
We thank the participants of this study.
Support: Dr Grubbs was supported by grant 1K23DK093710-01A1 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and by the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation. Dr Tuot was supported by grant K23DK094850 from the NIDDK. Funders of this study had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report
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