DECISION-MAKING ACROSS THE CKD TRAJECTORY: A QUALITATIVE INTERVIEW STUDY WITH CALD PATIENTS

D MUSCAT1, R KANAGARATNAM1, H SHEPHERD1, K SUD2-4, K MCCAFFERY1, A WEBSTER1,4

1University of Sydney, School of Public Health, New South Wales, Australia; 2University of Sydney, Sydney Medical School, New South Wales, Australia; 3Nepean Hospital, Department of Renal Medicine, New South Wales, Australia; 4Westmead Hospital, Centre for Transplant and Renal Research,  New South Wales, Australia

Background: Patients from culturally and linguistically diverse (CALD) backgrounds experience higher prevalence of chronic kidney disease (CKD) with a more rapid progression to dialysis. However, they are less likely to engage in decision-making about their health, with few interventions to support them to do so.

Aims: To explore the experience of decision-making throughout the CKD trajectory among CALD patients with Stage 5 CKD who are currently receiving haemodialysis, with a focus on core value influences on medical decision-making processes.

Methods: Semi-structured interviews were conducted with CALD patients at haemodialysis units in Western Sydney, Australia. Purposive sampling was used to target Arabic-speakers and English-speakers from the Indian subcontinent and Pacific Islands. Interviews were audio-recorded, transcribed, and analysed using Framework Analysis.

Results: Interviews were conducted with 26 participants (74% participation) between January and April, 2017. Many participants indicated that they wanted to be informed about their health and participate in decision-making. However they felt constrained by perceptions of power imbalance in the physician-patient dyad and experienced difficulty understanding a set of questions to support shared decision-making (SDM). Participants reported using more passive decision-making styles and feeling disconnected with the decision-making process “we weren’t given a choice…” [NIHU01].

Family and religion emerged as central to participants’ cultural identity and influenced their perceptions of health and decision-making. Participants reinforced community interdependence citing religious institutions as a support network and faith as a source of strength during illness.

Conclusions: Interview findings demonstrate the need for targeted and tailored SDM interventions that simultaneously acknowledge and address culturally-specific barriers and promote patient participation in line with patient preferences.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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