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Conceptualizing Chronic Kidney Disease Dialysis Modality Decision-Making and Home-Dialysis Service Usage Open Access


Other title
Critical Realism
Chronic Kidney Disease
Type of item
Degree grantor
University of Alberta
Author or creator
Harwood, Lori E
Supervisor and department
Clark, Alex M (Nursing)
Examining committee member and department
Cranley, Lisa (Nursing)
Thirsk, Loraine (Nursing)
Bukola, Salami (Nursing)
Spiers, Jude (Nursing)
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Abstract People with Chronic Kidney Disease (CKD) are asked to make important decisions about if, where and how they will receive dialysis. As the population in Canada ages with increased co-morbidity such as diabetes and hypertension, the need for high cost treatments for CKD such as dialysis will persist. However, understanding the complexity of these decisions and influences of decision-making related to these treatments is limited. This work was undertaken to conceptualize the complexity of CKD modality decision-making with a focus on home-dialysis and older adults. Critical realism provided the framework for this inquiry. This paper-based dissertation includes an introductory chapter, four publishable papers and a discussion chapter. The first paper conceptualizes dialysis modality decision-making using critical realism and serves as the theoretical framework for this work. The second paper is a systematic literature review and meta-ethnography of the qualitative research on dialysis modality decision-making. The third paper is a quantitative study which examines the relationship between chronic kidney disease stressors as determinants of dialysis modality service usage. The forth paper, describes a qualitative study exploring home-dialysis modality decision-making for aging adults with advanced kidney disease. The conclusion of this dissertation is a discussion of the complete thesis, and includes implications for practice, policy and research.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Harwood, L. & Clark, A.M. (2014). Dialysis modality decision-making for older adults with chronic kidney disease. Journal of Clinical Nursing. 23, 3378-3390.Harwood, L. & Clark, A.M (2012). Understanding health decisions using critical realism: Home-dialysis decision-making during chronic kidney disease. Nursing Inquiry, 19(1), 29-38.Harwood, L. & Clark, A.M. (2012). Understanding pre-dialysis modality decision-making: A meta-synthesis of qualitative studies. International Journal of Nursing Studies. 50, 109-120.Harwood, L., Wilson, B., Sontrop, J. & Clark, A.M. (2012). Chronic kidney disease stressors influence choice of dialysis modality. Journal of Advanced Nursing. 68(11), 2454-2465.

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