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Why end-stage renal patients choose not to have dialysis
  1. Helen Noble, Doctoral Student/Senior Clinical Nurse Specialist,
  2. Julienne Meyer, Professor of Nursing,
  3. Jackie Bridges, Senior Research Fellow,
  4. Daniel Kelly, Reader in Cancer and Palliative Care and
  5. Barbara Johnson, Senior Lecturer
  1. Helen Noble is Doctoral Student/Senior Clinical Nurse Specialist, Renal Supportive Care, City University, Institute of Health Science, St Bartholomew School of Nursing and Midwifery, London, Julienne Meyer is Professor of Nursing, Care for Older People, and Dr Jackie Bridges is Senior Research Fellow, City University, Dr Daniel Kelly is Reader in Cancer and Palliative Care, Middlesex University, London, Dr Barbara Johnson is Senior Lecturer, City University, Barts and The London NHS Trust, London. Email: H.R.noble{at}


End-stage renal disease will result in death if it is not treated with dialysis. However, some patients decide not to embark on dialysis. The reasons for this are unclear. Factors such as general ill health, frailty and pre-existing co-morbidities may hinder the success of dialysis and make the intervention unlikely to prolong life. This review examines the literature concerned with the decision not to have dialysis. It highlights a lack of evidence to inform practice, with only three papers available worldwide relating to the decision not to have dialysis. Themes uncovered include: age and quality of life; desire not to be a burden; and doctor/patient issues such as prognostic uncertainty and a sense of abandonment. There is an urgent need for more research in this area so reasons why patients decide not to embark on dialysis is more fully understood. Although specific to renal patients, this article has relevance for all nurses caring for patients deciding not to undergo ‘life-saving’ treatment. In the case of dialysis, it is often debatable whether or not the treatment will be successful. Conflicts of interest: none

  • End of life
  • End-stage renal disease
  • Forgoing dialysis
  • Palliative care
  • Supportive care

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