Exploration of Factors that Impact Mode of Death in the Hemodialysis Patient.

Hemodialysis patients' modes of death have implications for themselves, their significant others, and health care providers. For physical and psychological needs of hemodialysis patients and significant others to be met, it is important to understand factors that influence the patient's mode of death. Knowledge of factors that influence hemodialysis patients' mode of death may help health care providers more effectively care for these hemodialysis patients and significant others. The purpose of this exploratory study was two fold. One was to determine the demographic variables and intentioned or unintentioned mode of death for hemodialysis patient's as listed on the ESRD Death Notification form. Secondly, it was to retrospectively explore with the significant other perceptions as to the patient's cause of death, and the end-of-life experiences of individual's living with end stage renal disease (ESRD), focusing on the nature of the illness trajectory, social integration, role change, and social support.

Life experiences of patients with ESRD entail managing the illness trajectory and the work involved in that management. Illness trajectory refers not only to the physiological unfolding of the disease, but also to the organization of work related to the impact of the disease on those involved (Corbin & Strauss, 1988). An illness trajectory requires the combined efforts of patients and significant others in order to cope with the illness, determine its outcome, manage any symptoms, and handle any disability (Corbin & Strauss, 1992).

Social support and the use of palliative coping strategies have been reported to be significant predictors in the process of adjusting to chronic illness. One study indicated that the greater the perceived social support, the better the psychosocial adjustment to the chronic illness (Gurklis & Menke, 1995). Flaherty and O'Brien (1992) found high levels of social support and the use of palliative coping strategies to be significant predictors in the process of adjusting to a chronic illness.

The treatment regimen not only requires major lifestyle adaptations, but many individuals and families must also adjust to a loss of social roles and disruption of family roles (Foxall, Eckberg, & Griffith, 1986; O'Brien, 1983). Brinker and Lichtenstein (1981) noted that role change is common in dialysis families such that spouses often take on the roles of the sick partner while maintaining their own role. Hemodialysis patients not only are unable to maintain social roles, but may also be unable to integrate into religious, domestic, and political groups due to lifestyle changes.

When individuals are diagnosed with ESRD they and their significant other undergo major changes. Individuals and significant others must learn to manage the trajectory of the illness by handling time consuming treatments, diet and fluid restrictions, changes of social roles, disruption of family roles, and altered life goals. Whereas 47% of ESRD patients undergoing hemodialysis treatments died of unintentioned causes such as cardiac arrest or cerebral vascular accident, in 1992 approximately 17% of patients died from intentioned causes after withdrawal from hemodialysis treatment (USRDS, 1995).

The research questions that guided this study were:

1. What was the mode of death for hemodialysis patients in this study?