Religious beliefs and practices in end-stage renal disease: Implications for clinicians

Context: Several components of palliative care are particularly applicable in end-stage renal disease (ESRD), including the spiritual domain. Objectives: To investigate how ESRD patients and their families make decisions and cope with their circumstances and dialysis treatment. Methods: A prospective qualitative study interviewed 31 elderly dialysis patients and their family members; interviews lasted 30-90 minutes. Interviews were transcribed and coded independently by three investigators. The codes were collected into content-specific "nodes" and themes. Investigators identified and reconciled their interpretations by returning to the transcripts to assure that conclusions reflected participants' sentiments. Results: Five themes pertaining to religious beliefs and practices emerged. Two themes were related to decision making: their faith-based beliefs and the meaning that emerges from these beliefs; two described how their coping is impacted: the participants' religious practices and their perceived support from the church community; and one described the participants' spiritual distress. Conclusion: These findings offer insights into chaplains' roles in the ESRD setting and the issues that they and other palliative care team members can anticipate and address in patient support and decision making. The results also support recent work to develop methodologies for research on religious and spiritual issues in medical settings.