Treatment decisions for patients and end-stage renal disease: psychological considerations

Consideration of psychological factors can lead to more informed treatment decisions and more successful medical management of patients with end-stage renal disease. Several criteria are specified as a useful guide. The psychological issues of dependence-independence, activity-passivity, and control and mastery are frequently referred to in the literature as being important in understanding the chronic stress of illness and treatment. Treatment planning should be tailored, if possible, to the psychological needs of the patient, the family and the staff. The process of adaptation to chronic dialysis and kidney transplantation are discussed. Several clinical vignettes are presented to illustrate the importance of psychological considerations in making "good fit" between patient and treatment modality.