Factors influencing patient selection of dialysis treatment modality

To identify factors that influence selection of a dialysis treatment modality by patients with renal failure.

Qualitative, using grounded theory method.

Twenty subjects were selected from dialysis populations in urban and rural Nebraska and in Southern California. Theoretical sampling was used to guide subject selection.

Data gathered through interviews were taped and transcribed verbatim. Constant comparative analysis was used to identify patterns, develop categories, and guide further interviews.

A two-stage model was developed. The first stage contains the processes of valuing and evaluating perceived threats. During the second stage, weighing alternatives, individuals compare the benefits and concerns of each dialysis modality and choose the modality that maximally supports identified values and minimizes the number of threats.

The selection process is influenced by the presence or absence of basic resources, for example, quality and timing of information, prior placement of vascular access, and social and family support systems. Nurses can support the modality selection process by identifying and reducing threats and by enhancing or altering basic resources.