Interpretative Phenomenological Study Exploring Why People With Kidney Failure Say 'No' to a Kidney Transplant

Area of Science:

• Qualitative Health Research
• Transplantation Science
• Patient Decision-Making Studies

Background:

• Kidney transplantation is a preferred treatment for kidney failure.
• Understanding patient refusal of kidney transplants is vital for improving care.
• Previous research has not fully explored the multifaceted reasons for declining transplants.

Purpose of the Study:

• To explore in-depth perceptions and experiences of decision-making among individuals who declined kidney transplants.
• To identify the reasons behind the refusal of kidney transplant opportunities.

Main Methods:

• Qualitative interpretative phenomenological analysis informed by the Theory of Planned Behaviour.
• Semi-structured interviews with 30 adults in the UK who declined a kidney transplant (August 2022 - June 2023).
• Verbatim transcription and analysis of digitally recorded interviews.

Main Results:

• The decision against kidney transplant was concrete for most participants.
• Four cross-cutting themes emerged: impact of negative past experiences, negative attitudes/beliefs, preference against transplant, and perceived benefits of declining.
• Mistrust from prior negative experiences, fear of transplant failure, perceived age unsuitability, and COVID-19 concerns influenced decisions.

Conclusions:

• Decisions against kidney transplantation were carefully considered, multifaceted, and informed by personal experiences, risks, and values.
• Recognizing these factors is essential for patient-centered care and shared decision-making.
• Nurse-led education should balance promoting transplantation while respecting patient autonomy.