Exploration of factors that impact mode of death in the hemodialysis patient.

The purpose of this quantitative and explorative qualitative study was to examine the illness trajectory, social integration, role change, and social support that may have influenced hemodialysis patients' mode of death. A quantitative archival medical record review recorded patients' mode of death as listed on the End Stage Renal Disease (ESRD) Death Notification form. Exploratory interviews were conducted with the deceased hemodialysis patient's significant other to explore patient's illness trajectory, end-of-life experiences, social integration, role change, and social support. Seventeen patients experienced a sudden, unexpected, unintentioned death, and 15 patients experienced an intentioned death after withdrawal of hemodialysis. Qualitative indicators of illness trajectory indicated either a fairly slow downward course with a sudden unintentioned death or a rapid downward spiraling course resulting in intentioned death after withdrawal of hemodialysis. While it was unknown if significant others would report of individuals withdrawing from treatment who lacked social integration or social support, findings suggest that some individuals in this study withdrawing from hemodialysis exercised their rights to self-determination and right to refuse life-saving treatments. Although findings of this study are not generalizable, it may be advisable for nurses to engage patients and family members in discussions regarding advance directives, rights to refuse treatment, and withdrawal from hemodialysis prior to a change in the patient's illness trajectory.