End-of-life decision-related survey of patients requiring chronic dialysis

Introduction: decisions in connection with the end of life are frequent in the context of nephrology. In spite of their arising in different contexts, only suspension of chronic dialysis has been quantified, accounting for 7% of deaths in dialysis. Objective: to learn about attitudes and criteria of Uruguayan nephrologists upon the making of decisions in connection with the suspension of treatment or failing to include patients in chronic dialysis. Method: online anonymous and volunteer survey among Uruguayan nephrologists. The following questions were made on three clinical situations: What would you do?, and Who would you consult in each one of the cases?. The study explored demographic data, professional expertise, knowledge about legal provisions and degree of perceived skills to face such situations. Results: sixty five nephrologists participated in the survey: 77% women, 84% of them with over ten years of practice as an expert. When asked: "one of your patients on dialysis has evolved into a severe and permanent dementia", 66% answered "I probably decide suspension of dialysis". Upon a competent patient who requests the suspension of dialysis, 86% of doctors try to continue with treatment. If "a request is made to initiate chronic dialysis in a patient under persistent vegetative state"; 100% answered: "I would probably not start dialysis". Upon all situations described, they would consult the patient/family and other experts in the team. Twenty four out of 63 believe they are "prepared" or "very well prepared" to make these decisions. Knowledge about legal provisions proved to be scarce and they ignore protocols that provide guidelines for the making of these decisions. Conclusions: Uruguayan nephrologists adopt rather uniform criteria for the treatment of patients on dialysis in severe or irreversible situations, and they act in agreement with family members and other professionals. We need guidelines with medical, ethical and legal criteria to approach these situations.