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The article describes a secondary analysis of a qualitative study designed to identify factors that influence clients' decisions regarding type of dialysis treatment modality. The original qualitative study was designed to elicit perceptions of clients with end-stage renal disease regarding why, how, and by whom the decision was made about the type of dialysis treatment modality (hemodialysis or continuous ambulatory peritoneal dialysis) that the client would undergo. Secondary analysis of the original study results revealed that the factors that influenced the decision regarding the type of dialysis treatment modality encompassed the five Neuman systems model variable areas: physiologic, psychologic, sociocultural, developmental, and spiritual.

Objective: The purpose of this qualitative study was to elicit patients' perceptions of why, how, and by whom their dialysis treatment modality--hemodialysis or continuous ambulatory peritoneal dialysis (CAPD)--was chosen., Design: The study design utilized a naturalistic method of inquiry employing a qualitative approach. The research was guided by the life-death decisions in health care framework developed by Degner and Beaton and the Neuman Systems Model., Sample/setting: Twenty-two informants were recruited from inpatient and outpatient renal dialysis units at a large urban tertiary care center on the east coast of the United States., Methods: Data were collected by individual, focused, semi-structured in-depth interviews., Results: A grounded theory, "Patient's Choice of a Treatment Modality versus Selection of Patient's Treatment Modality" emerged from the data provided by the informants. The theory consisted of 11 themes that addressed the why, how, and by whom of decision-making: self decision; access-rationing decision; significant other decision; to live decision; physiologically dictated decision; expert decision; to-be-cared-for decision; independence verses dependence decision; no patient choice in making decision; patient preference/choice; and switching modalities due to patient preference/choice., Conclusion: The themes reflected two patterns of decision-making: the patient and/or significant other chose the treatment modality, and the treatment modality was selected because of clinical or practical circumstances.