End of life of patients treated with haemodialysis as narrated by their close relatives
Sammanfattning
Aim:
The study aimed to describe end of life for patients treated with maintenance haemodialysis as
narrated by their close relatives.
Introduction:
Many patients undergoing haemodialysis are older, have several comorbidities and underestimated
symptoms and are in their last year of life. To improve care, we need to know more about their end-
of-life situation.
Design:
Qualitative and descriptive.
Methods:
Qualitative retrospective interviews were conducted with 14 close relatives of deceased
haemodialysis patients (3-13 months after death). Data were analysed using qualitative content
analysis. The study is ethically approved.
Findings:
In the last months, a gradual deterioration in health with acute episodes necessitating hospital
admissions was described. This involved diminishing living space and expressions of dejection, but
also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades
away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following
intensive care. Findings show complexities of decisions on haemodialysis withdrawal.
Conclusions:
Different end-of-life patterns all involved increasingly complex care needs and existential issues.
Findings show a need for earlier care planning. The identification of organisational factors to facilitate
continuity and whole person care to meet these patients' specific care needs with their complex
symptom burdens and comorbidities is needed. Findings indicate the need for integration of a
palliative care approach in the treatment of patients in haemodialysis care.