Decisional Conflicts in Kidney Replacement Therapy for Patients With Grade 5 Chronic Kidney Disease: A Qualitative Meta-Synthesis.

Abstract

<h4>Background</h4>Patients with chronic kidney disease are faced with complex decisions on kidney replacement therapy, which are prone to conflict and affect the quality of decision-making.<h4>Objectives</h4>To systematically review and synthesise qualitative evidence related to decisional conflicts regarding kidney replacement therapy in patients with Grade 5 chronic kidney disease.<h4>Design</h4>CINAHL, Embase, Web of Science, Cochrane Library, MEDLINE, PubMed, OvidPsycINFO, CNKI, VIP, Wan Fang Database, and Sino Med were searched from the time of database establishment to March 2025.<h4>Results</h4>Overall, 15 studies involving 488 participants were included. We identified the following six themes related to decisional conflicts: emotional conflicts (negative emotions about starting kidney replacement therapy and uncertainty about the future), physical conflicts, information conflicts about kidney replacement therapy (insufficient or overwhelming kidney replacement therapy information, different understanding of information, challenges in doctor-patient communication and information asymmetry), support conflicts (insufficient kidney replacement therapy decision-making support), weak willingness to make decisions to kidney replacement therapy and others.<h4>Conclusions</h4>Patients with Grade 5 chronic kidney disease experience decisional conflicts, including severe negative emotions, insufficient awareness of kidney replacement therapy decision-making, insufficient or overwhelming information, and weak decision-making support. Healthcare professionals should be aware of these conflicts and offer personalised discussions to improve kidney replacement therapy decision-making in clinical practice.