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CHAPTER 12










                DIALYSIS OR NO DIALYSIS





        WHAT IS CONSERVATIVE                                           TALKING TO YOUR FAMILY
        MANAGEMENT?
                                                                ● This may be difficult, as your family may not
                    ot all patients do well on dialysis. For
                                                                   agree with your decision. If you feel it would
                   some there is a marked deterioration in
                                                                   help, consider having a facilitator present
                   quality of life, though it is not entirely
                                                                   (someone you trust, or someone from the
                   predictable.    Some     people     may
                                                                   renal team, if they are agreeable).
        Nexperience dialysis as an excessive
        burden, providing no benefit at all. Patients who are   ● Using your notes, outline the reasons for your
        struggling with many health problems may                   decision.
        reasonably wonder if dialysis will make their life      ● Listen to your family, acknowledge their
        any better or will it prolong suffering.                   concern and reply in a calm manner.
           If you decide not to start dialysis, your care will  ● You are aiming to reach a point where your
        be managed under a programme called                        family understand the reasons you are
        Conservative Management. This means you receive            making this decision. However be prepared,
        all aspects of kidney care i.e. regular clinic visits,     they may not all be in agreement with you.
        diet management, with the exception of dialysis.
        Your GP may also be involved in your care.
                                                                 TALKING WITH YOUR CONSULTANT

        WHAT IS THE FIRST STEP                                  ● Try to avoid using a clinic appointment to
        I SHOULD TAKE?                                             discuss such complex issues. If possible make
           Write down your hopes and concerns. Making              an appointment for another time, where you
        notes may help clarify the reasons behind your             will have adequate time to explore all your
        thinking, leading to a more informed choice.               options.

                                                                ● Your notes will guide you. It is important to
        WHO SHOULD I TALK TO?                                      have your questions written down in front of
           The primary people you should talk to are your          you.
        family and your consultant. Your written notes re:      ● It may be helpful to have a family member
        concerns/hopes can act as a basis for the                  accompany you to this meeting..
        discussion.



                                    CAN MOOD INFLUENCE MY DECISION?

        If depression is suspected your doctor will suggest an assessment, to ensure a depressive episode is not
        a contributory factor to your decision. If depression is diagnosed, appropriate interventions in the form of
        therapy with or without medication, will be discussed with you.






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