Facilitating intrinsic motivation regarding the initiation of hemodialysis in an elderly patient with end-stage renal disease by promoting ambivalence towards treatment-related fear and anxiety

Abstract

Keywords： refusal of treatment, refusal of dialysis, psychological interventions, intrinsic motivation, motivational interviewing 〈Abstract〉 Patients are frequently forced to make decisions about their treatment plans, leading to conflict between patients, medical teams, and family members. During discussions about the initiation of hemodialysis, some patients with end-stage renal disease are faced with changes and challenges associated with being dialysis patients that cause them to refuse treatment. There is a concern that patients with chronic renal failure might be forced to initiate dialysis against their will, and thereby, suffer worse outcomes and a low quality of life. Therefore , it is worthwhile for clinicians to understand how to support such patients to make decisions. Giving medical advice or persuasion is not only less effective, but can also evoke anxiety or dissatisfaction about treatment. Conversely, activating intrinsic motivation regarding treatment is important because it develops naturally within the individual and not only increases favorable behaviors, but also helps to sustain them for years. Here, we present the case of an elderly patient with renal failure, who refused to start undergoing hemodialysis because of a strong sense of fear based on his prior experience of urgent dialysis. We repeatedly promoted ambivalence concerning his fear and hope regarding the treatment, thereby facilitating intrinsic motivation. As a result, the 前川 道隆 藤田医科大学ばんたね病院腎臓内科 〒 454-8509 愛知県名古屋市中川区尾頭橋三丁目 6-10 Michitaka Maekawa Tel ： 052-321-8171 Fax： 052-322-4734 E-mail ： m_mae_81@yahoo.co.jp 〔受付日：2019 年 12 月 23 日，受理日：2020 年 3 月 11 日〕