BMJ, doi: 10.1136/bmj.38965.626250.55, (Published 21 September 2006)

RESEARCH

Hope and advance care planning in patients with end stage renal disease: qualitative interview study

Sara N Davison ^1* Christy Simpson ²

¹ Division of Nephrology and Immunology, University of Alberta, Edmonton, Alberta, Canada
² Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada

^* Correspondence to: sara.davison{at}ualberta.ca.

Objective To understand hope in the context of advance care planning from the perspective of patients with end stage renal disease.

Design Qualitative in-depth interview study.

Setting Outpatient department of a university affiliated nephrology programme.

Participants 19 patients with end stage renal disease purposively selected from the renal insufficiency, haemodialysis, and peritoneal dialysis clinics.

Results Patients' hopes were highly individualised and were shaped by personal values. They reflected a preoccupation with their daily lives. Participants identified hope as central to the process of advance care planning in that hope helped them to determine future goals of care and provided insight into the perceived benefits of advance care planning and their willingness to engage in end of life discussions. More information earlier in the course of the illness focusing on the impact on daily life, along with empowerment of the patient and enhancing professional and personal relationships, were key factors in sustaining patients' ability to hope. This helped them to imagine possibilities for a future that were consistent with their values and hopes. The reliance on health professionals to initiate end of life discussions and the daily focus of clinical care were seen as potential barriers to hope.

Conclusions Facilitated advance care planning through the provision of timely appropriate information can positively enhance rather than diminish patients' hope. Current practices concerning disclosure of prognosis are ethically and psychologically inadequate in that they do not meet the needs of patients.

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(Accepted 23 August 2006)
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