Experiences of carers supporting dying renal patients managed without dialysis
Article first published online: 20 NOV 2012
© 2012 Blackwell Publishing Ltd
Journal of Advanced Nursing
Volume 69, Issue 8, pages 1829–1839, August 2013
How to Cite
2012) Experiences of carers supporting dying renal patients, managed without dialysis. Journal of Advanced Nursing 69(8), 1829–1839. doi: 10.1111/jan.12049, & .(
- Issue published online: 11 JUL 2013
- Article first published online: 20 NOV 2012
- Manuscript Accepted: 13 OCT 2012
- palliative care;
- qualitative research;
- stage 5 chronic kidney disease
To explore the impact of being a family carer to patients with stage 5 chronic kidney disease managed without dialysis.
Increasing numbers of patients with renal disease worldwide are making the decision not to embark on dialysis. This group has significant physical and psychological symptom burdens similar to or greater than those in advanced cancer patients. Little is known about the impact on family carers.
Exploratory, qualitative design.
The study was undertaken with 19 carers caring for patients managed in a Renal Supportive Care Service in the UK between 2006–2008. Sixty-one semi-structured interviews and detailed field notes inform the analysis.
‘Caring from diagnosis to death’ was the overarching theme illustrated by three sub-themes: (i) Caregiver's plight – making sense of the disease and potential deterioration; (ii) Having to care indefinitely; and (iii) Avoiding talk of death. ‘Caring from diagnosis to death’ coincides with an original concept analysis of renal supportive care, which is considered an adjunct to the management of patients with renal disease at all stages of their illness.
There is a clear need for further research internationally and theory-based nursing interventions to support carers of patients managed without dialysis. The development of a holistic, integrated care pathway based on carer perspectives, which includes identification of information needs related to original diagnosis, associated comorbidities, treatment options, prognosis, and assistance in developing strategies to manage communication with patients as the end of life approaches, is required.