A Systematic Literature Review of Relational Autonomy in Dialysis Decision Making

Area of Science:

• Nephrology
• Bioethics
• Medical Sociology

Background:

• Ethical medical practice prioritizes patient autonomy and self-determination through shared decision-making (SDM).
• Healthcare professionals must consider cultural diversity and community influences on patient values during SDM.
• Relational autonomy in chronic kidney disease (CKD) and end-stage kidney disease (ESKD) SDM remains underexplored.

Purpose of the Study:

• To systematically review literature on SDM in CKD.
• To explore the concept of relational autonomy within the context of dialysis decision-making.

Main Methods:

• Systematic literature review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework.
• Identification and synthesis of peer-reviewed literature on SDM in CKD.

Main Results:

• Autonomy is fundamental to compassionate medical care.
• Providers must acknowledge and address their social power imbalance with patients.
• Patient autonomy is influenced by their social and cultural context.
• Dialogue is essential for aligning clinical recommendations with patient goals.

Conclusions:

• Promoting autonomy through dialogue, acknowledging interdependence and patient context, supports relational autonomy in dialysis decisions.
• Ethical nephrology care requires understanding the patient's social-relational situatedness.
• Further research and practice should integrate relational autonomy principles into dialysis decision-making.