Problem statement

ANSWER

Problem Statement

There has been much debate in the medical community about the patient’s right to refuse dialysis when they have End Stage Renal Disease (ESRD). The patient’s quality of life, values, and beliefs, as well as the potential risks and benefits of dialysis, should all be taken into account when deciding whether to accept or continue dialysis. However, it is frequently necessary to respect and consider the patient’s wishes, which can result in disagreements between the patient, family, and care team as well as a number of ethical and legal problems. The patient’s quality of life may be significantly impacted by those problems. To ensure a successful decision-making process, it is critical to take into account the patient’s autonomy, the perspectives of all stakeholders, the risks and benefits of dialysis, and the requirement for open communication between all stakeholders.

Literature Review

A global epidemic of chronic diseases and an aging population are both contributing to an increase in the prevalence of end-stage renal disease (ESRD). A rapidly aging population and a high incidence of diabetes are prevalent in nations like the United States, where ESRD is a serious health problem that affects many patients and is diagnosed yearly (Cotter et al., 2021). Dialysis and kidney transplantation have historically been the two treatments for ESRD; both involve lifestyle changes and may have a significant negative impact on the physical and mental health of those who are affected. While conservative management cannot reverse ESRD, it can help patients better manage their symptoms and gain more control over their lives. Recent studies have highlighted the significance of one’s values regarding life and death when thinking about dialysis (Mukakarangwa et al., 2018). But more research on decision-making in ESRD patients is required (Ladin et al., 2022). This may take the form of elements like practical and financial concerns, as well as cultural values of collectivism and interdependence in the United States. It is important to comprehend how attitudes toward health and illness may affect choices. This knowledge can help create decision-support programs that are sensitive to cultural differences, both locally and in the majority of healthcare facilities that have a sizable population of ESRD patients with Asian ancestry.

Outline

The decision-making process and causes of dialysis treatment refusal among non-Western ESRD patients in Singapore will be examined in this paper. Beginning with a review of the literature on ESRD and current therapeutic modalities with an emphasis on the significance of conservative management. Following that, it will examine the practical, financial, and cultural factors that contribute to non-Western patients’ refusal to undergo dialysis. The potential ramifications for creating decision support tools that are culturally aware will then be discussed. In general, the paper will wrap up by outlining the key conclusions and pointing out any potential gaps in the literature.

References

Cotter, T. G., Wang, J., Peeraphatdit, T., Sandıkçı, B., Ayoub, F., Kim, G., Te, H., Jeevanandam, V., Sabato, D., & Charlton, M. (2021). Simultaneous heart–liver transplantation for congenital heart disease in the United States: Rapidly increasing with acceptable outcomes. Hepatology, 73(4), 1464–1477. https://doi.org/10.1002/hep.31426

Cotter, T. G., Wang, J., Peeraphatdit, T., Sandıkçı, B., Ayoub, F., Kim, G., Te, H., Jeevanandam, V., Sabato, D., & Charlton, M. (2021). Simultaneous heart–liver transplantation for congenital heart disease in the United States: Rapidly increasing with acceptable outcomes. Hepatology, 73(4), 1464–1477. https://doi.org/10.1002/hep.31426

Ladin, K., Lin, N., Hahn, E., Zhang, G., Koch-Weser, S., & Weiner, D. E. (2016). Engagement in decision-making and patient satisfaction: A qualitative study of older patients’ perceptions of dialysis initiation and modality decisions. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfw307

Ladin, K., Lin, N., Hahn, E., Zhang, G., Koch-Weser, S., & Weiner, D. E. (2022). Engagement in decision-making and patient satisfaction: a qualitative study of older patients’ perceptions of dialysis initiation and modality decisions. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfw307

Mukakarangwa, M. C., Chironda, G., Bhengu, B., & Katende, G. (2018). Adherence to hemodialysis and associated factors among end-stage renal disease patients at selected Nephrology units in Rwanda: A descriptive cross-sectional study. Nursing Research and Practice, 2018, 1–8. https://doi.org/10.1155/2018/4372716

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