Decisional Conflict and Patient Experiences in Dialysis Treatment Decision-Making: A Mixed-Methods Study in a...

Background/Objectives: Choosing a treatment modality for kidney failure represents one of the most complex decisions faced by patients with advanced chronic kidney disease. Decisional conflict may arise when patients feel uncertain, insufficiently informed, or unclear about their personal values, potentially affecting treatment satisfaction and long-term adaptation. This study examined decisional conflict among patients initiating dialysis and explored how patients described their experiences during the decision-making process. Methods: This exploratory mixed-methods study was conducted at a university-affiliated hospital in Portugal and included 32 adults initiating dialysis following structured pre-treatment education about kidney failure treatment options. Decisional conflict was assessed using the Decisional Conflict Scale, and sociodemographic data were collected. Participants' reflections expressed during questionnaire administration were documented verbatim and evaluated using thematic analysis. Quantitative data were analyzed using non-parametric statistics. Results: Overall decisional conflict levels were low, although the uncertainty subscale showed a moderate mean score. Twenty-five percent of participants reported moderate to high uncertainty regarding decision implementation. Age was positively associated with the "informed" subscale, suggesting that older participants reported greater difficulty feeling adequately informed during decision-making. Qualitative findings identified three themes: lack of engagement in decision-making, perceived absence of choice, and resignation and coping. These themes reflected the influence of clinician authority, the perception of dialysis as an inevitable life-preserving intervention, and patients' emotional adaptation to treatment. Conclusions: Decisional conflict during dialysis initiation appears to be shaped by the interplay between information exchange, values clarification, and perceived autonomy. These findings highlight the importance of patient-centered communication strategies that support deliberation and meaningful engagement in treatment decisions.