Prolonging Life or Prolonging Death: Communication's Role in Difficult Dialysis Decisions

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Abstract
This article investigates the importance of treatment requests made by patients with kidney failure and other life-threalening conditions on nephrologists' treatment decisions A total of 535 nephrologists from the U.S., Canada, and Britain returned mailed surveys in which they read 5 scenarios and then indicated how the patient described in the scenario should be treated. Results revealed that when patients communicated their preferences, nephrologists were significantly more likely to provide dialysis. Although there were no differences among the 3 countries when treatment preferences were not expressed, Americans were much more likely to provide dialysis when requested by Ihe patient. Whereas most nephrologists agreed to change treatment decisions at the request of the patient, American doctors were less likely to comply with requests to terminate dialysis and were more likely to agree to provide dialysis for incompetent patients they initially refused to dialyze if asked to do so by the family. In the 3 scenarios in which the patients' treatment preferences were unstated, approximately 45% of the doctors who recommended dialysis still cited the patient's request for dialysis as the most important factor in their decision.