PATIENT PERSPECTIVES ON DECISION MAKING IN DECEASED DONOR KIDNEY TRANSPLANT OFFERS: A QUALITATIVE STUDY
DR ALISION WEIGHTMAN1,2,3, EMILY DUNCANSON1, 5, DR SIMON COGHLAN4, A/PROF PHILIP CLAYTON1,2,3
1ANZDATA, Adelaide, Australia, 2Adelaide Medical School, University of Adelaide, Adelaide, Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 4Centre for Artificial Intelligence and Digital Ethics, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia, 5School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
Aim: To explore the experiences and perspectives of recent kidney transplant recipients regarding decision making at the time of deceased donor kidney transplant offers, including views on information sharing practices and preferred roles for both doctors and patients.
Background: Evaluating deceased donor kidney transplant offers is a complex task. While it is important for prospective recipients to participate in these decisions, this can pose challenges. Currently there is limited research into the preferences of patients involved in these decision making processes.
Methods: Semi-structured interviews were conducted with 20 recent kidney transplant recipients from South Australia and the Northern Territory. Transcripts underwent thematic analysis.
Results: Four key themes were identified: emphasis on the operational (including subthemes of offer acceptance as a foregone conclusion, time sensitive decision making and overcoming practical barriers), outsourcing decision making (trusting the experts, overwhelm at the time of offer and kidney disease as a family affair), the perfect offer (transplant as the panacea, rewarding patience and finding a donor like me) and risk avoidance (rejecting compromise, intuitively shared priorities and fear of accumulating complications).
Conclusions: When considering kidney transplant offers, potential recipients prioritise practical problem solving over abstract risk-benefit analyses. They are acutely aware of their own knowledge limitations and desire expert guidance about the right course of action. Participants expressed their hopes for optimal transplant outcomes and were eager to minimise their risk exposure to avoid complications; they expected their doctors to implicitly understand these priorities. There is a need for further research to explore these issues from the perspective of the transplant doctors in order to compare expectations and clarify ideal decision making roles.
Biography:
Dr Alison Weightman is a consultant nephrologist at the Royal Adelaide Hospital. She is currently undertaking a PhD examining decision making in kidney transplant offers using qualitative methodologies and bioethical analysis.