Page 32 - Support Magazine Winter 2017
P. 32

7.  Did you ever undergo PERITONEAL DIALYSIS (APD/CCPD or CAPD)?         Yes          No
           If Yes, why?                                                                      If No, why not?
           Tick the most important reasons with a maximum of 5.                             Tick the most important reasons with a maximum of 5.
            Effect on life expectancy                                                A kidney transplant was already available
            Effect on social life                                                         Treatment is not available in my hospital
            Effect on quality of life                                                   Lack of information about this treatment
            Treatment is affordable                                                  I am medically not suitable for this treatment
            Possible to work or study                                               I do not want to have treatment at home
            Possible to travel or go on holiday                                  Effect on life expectancy
            Flexibility to adjust the treatment schedule                     Effect on quality of life
            Limited number of hospital visits                                    Expensive
            Independence with this treatment                                  Effect on social life
            Dialysis more comfortable at home                                Difficult to work or study
            My doctor preferred this treatment                                Difficult to travel or go on holiday
            No other treatment possible                                           Treatment takes too much time
            My previous treatment failed                                          Discomfort with no supervision
            Other reason                                                                  Dislike of abdominal catheter
                                                            Fear of peritonitis (peritoneal infection)
                                                            Fear of gaining weight
                                                            My house is not suitable
                                                            No assistant available
                                                            My doctor did not offer me this treatment
                                                            Other reason

        8.  Did you ever receive a kidney transplant from a LIVING DONOR?        Yes          No
           (It is possible that you are now on another treatment)
           If Yes, why?                                                                      If No, why not?
           Tick the most important reasons with a maximum of 5.                             Tick the most important reasons with a maximum of 5.
            Effect on life expectancy                                                No living kidney donor was available for me
            Effect on social life                                                         Deceased kidney donor was available for me
            Effect on quality of life                                                   Treatment is not available in my hospital
            Treatment is affordable                                                  Lack of information about this treatment
            Possible to work or study                                               I am not healthy enough for transplantation
            Possible to travel or go on holiday                                  I am too old for transplantation
            Possible to become pregnant                                         I am preparing for transplantation
            Few dietary restrictions                                                   Expensive
            Limited number of hospital visits                                    I do not want to ask my family or friends to donate
            Lower risk of rejection                                                    Concerns about the health of a living donor
            I did not want to wait for a kidney from a deceased donor   Fear of kidney transplantation surgery
            Independence with this treatment                                  Fear that my body would reject the donor kidney
            My doctor preferred this treatment                                Dislike of taking immunosuppressive medication
            Other reason                                                                  I am against living organ transplantation
                                                            My doctor did not offer me this treatment
                                                            My doctor says dialysis is better for me
                                                            Other reason

        9. Did you ever receive a kidney transplant from a DECEASED DONOR?       Yes          No
           (It is possible that you are now on another treatment)
           If Yes, why?                                                                      If No, why not?
           Tick the most important reasons with a maximum of 5.                             Tick the most important reasons with a maximum of 5.
            Effect on life expectancy                                                Treatment is not available in my hospital
            Effect on social life                                                         Lack of information about this treatment
            Effect on quality of life                                                   I am not healthy enough for transplantation
            Treatment is affordable                                                  I am too old for transplantation
            Possible to work or study                                               I am currently on the waiting list
            Possible to travel or go on holiday                                  Expensive
            Possible to become pregnant                                         Kidney lasts for less time than kidney from living donor
            Few dietary restrictions                                                   Living kidney donor was available to me
            Limited number of hospital visits                                    I do not want to wait for a kidney
            Independence with this treatment                                  Fear of kidney transplantation surgery
            No living kidney donor was available for me                   Fear that my body would reject the donor kidney
            My doctor preferred this treatment                                Dislike of taking immunosuppressive medication
            Other reason                                                                  I am against deceased organ transplantation
                                                            My doctor did not offer me this treatment
                                                            My doctor says dialysis is better for me
                                                            Other reason
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