Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study.

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  • Additional Information
    • Affiliation:
      Saw Swee Hock School of Public Health, National University of Singapore, Singapore Singapore
      Duke NUS Medical School, Singapore Singapore
      Department of Renal Medicine, Singapore General Hospital, Singapore Singapore
      London School of Hygiene and Tropical Medicine, London UK
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Background: End‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits. Objective: This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis. Design: Qualitative study design using semi‐structured interviews. Setting and participants: Twenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers. Results: While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden. Discussion and conclusion: This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.
    • Journal Subset:
      Europe; Health Services Administration; Peer Reviewed; UK & Ireland
    • ISSN:
      1369-6513
    • MEDLINE Info:
      NLM UID: 9815926
    • Grant Information:
      This research was supported by the National Medical Research Council of Singapore, the Lien Centre for Palliative Care at Duke NUS Medical School and the National University Health System (NUHS) Singapore.Population Health Improvement Centre
    • Publication Date:
      20191031
    • Publication Date:
      20191031
    • DOI:
      http://dx.doi.org/10.1111/hex.12943
    • Accession Number:
      139230925
  • Citations
    • ABNT:
      HAN, E. et al. Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study. Health Expectations, [s. l.], v. 22, n. 5, p. 1100–1110, 2019. DOI 10.1111/hex.12943. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=139230925. Acesso em: 24 set. 2020.
    • AMA:
      Han E, Haldane V, Koh JJK, et al. Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study. Health Expectations. 2019;22(5):1100-1110. doi:10.1111/hex.12943
    • APA:
      Han, E., Haldane, V., Koh, J. J. K., Quek, R. Y. C., Ozdemir, S., Finkelstein, E. A., Jafar, T. H., Choong, H., Gan, S., Lim, L. W. W., Shiraz, F., & Legido, Q. H. (2019). Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study. Health Expectations, 22(5), 1100–1110. https://doi.org/10.1111/hex.12943
    • Chicago/Turabian: Author-Date:
      Han, Emeline, Victoria Haldane, Joel Jun Kai Koh, Rina Yu Chin Quek, Semra Ozdemir, Eric Andrew Finkelstein, Tazeen Hasan Jafar, et al. 2019. “Perspectives on Decision Making amongst Older People with End‐stage Renal Disease and Caregivers in Singapore: A Qualitative Study.” Health Expectations 22 (5): 1100–1110. doi:10.1111/hex.12943.
    • Harvard:
      Han, E. et al. (2019) ‘Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study’, Health Expectations, 22(5), pp. 1100–1110. doi: 10.1111/hex.12943.
    • Harvard: Australian:
      Han, E, Haldane, V, Koh, JJK, Quek, RYC, Ozdemir, S, Finkelstein, EA, Jafar, TH, Choong, H, Gan, S, Lim, LWW, Shiraz, F & Legido, QH 2019, ‘Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study’, Health Expectations, vol. 22, no. 5, pp. 1100–1110, viewed 24 September 2020, .
    • MLA:
      Han, Emeline, et al. “Perspectives on Decision Making amongst Older People with End‐stage Renal Disease and Caregivers in Singapore: A Qualitative Study.” Health Expectations, vol. 22, no. 5, Oct. 2019, pp. 1100–1110. EBSCOhost, doi:10.1111/hex.12943.
    • Chicago/Turabian: Humanities:
      Han, Emeline, Victoria Haldane, Joel Jun Kai Koh, Rina Yu Chin Quek, Semra Ozdemir, Eric Andrew Finkelstein, Tazeen Hasan Jafar, et al. “Perspectives on Decision Making amongst Older People with End‐stage Renal Disease and Caregivers in Singapore: A Qualitative Study.” Health Expectations 22, no. 5 (October 2019): 1100–1110. doi:10.1111/hex.12943.
    • Vancouver/ICMJE:
      Han E, Haldane V, Koh JJK, Quek RYC, Ozdemir S, Finkelstein EA, et al. Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study. Health Expectations [Internet]. 2019 Oct [cited 2020 Sep 24];22(5):1100–10. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=139230925