Quality decision making in dialysis

A patient approaching the final stage of his renal disease is faced with many difficult questions. Should he opt for a transplant or start on dialysis? In the case of dialysis, can he manage his treatment at home or will he need to be cared for in a clinic? Should be choose peritoneal dialysis or haemodialysis? Is the freedom of being independent from a machine, given by CAPD, as valuable as the freedom of having days without treatment, given by HD? The issues are complex and do not have a given answer. To make the proper decisions about his treatment the patient needs extensive information and support from the caregivers. Likewise, the caregivers need to know the patient well in order to give appropriate advice. In this exchange of information, the renal nurse has a very important role. Some patients may need to be dialysed in a hospital but most can get an equally good or even better dialysis treatment in a less stressful environment. A high degree of self-care is preferred by people who value independence and freedom of movement. Self-care also improves the self-confidence and increases the chances of maintaining employment and a rich social life. Self-care could mean both PD and HD, sometimes with the assistance of a spouse or a nurse. But a certain degree of self-care can also be maintained in limited-care centres and satellites, where the presence of nursing staff gives the feeling of security. For everybody involved, not least the purchasers of health care, it is desirable to keep the patients out of the costly hospital environment for as long as possible.