HERMENEUTICAL STUDY OF THE MEDICAL TREATMENT DECISION FOR END STAGE RENAL DISEASE PATIENTS AND THEIR FAMILIES (ORGAN TRANSPLANTATION, DIALYSIS).
Contributors: University of Kentucky.
Published: 1996
Number of pages: 232
Subjects: Sociology, Individual and Family Studies.; Health Sciences, Nursing.; Health Sciences, Medicine and Surgery.
Description: Little attention has been given to the decision making process end stage renal disease patients and their families undertake as they choose to initiate dialysis, continue life long dialysis treatment or pursue kidney transplantation. Thirty end stage renal disease patients and family members who were making or re-making this decision were interviewed. Heideggerian hermeneutic analysis techniques were used to analyze the end stage renal disease patient and family narratives from a phenomenologfical perspective. From this analysis, four constitutive patterns emerged as important considerations in the medical treatment decision making process: (1) surgery: more hospitals, more problems, (2) uncertainty: it's just not a sure thing, (3) illness-as-lived in structured silence, and (4) altruism: passing on the gift of life.

While concerns related to surgical invasion and the potential for rejecting the transplanted organ are easily understood by both patients and their health care professionals, altruist concerns of transplant-eligible patients have not been heard. Social phenomena which act as barriers to patient-careprovider dialogue include "moving on" and "labelling" and are themes of the illness-as-lived in structured silence pattern.

Once a treatment decision is made, patients and families must now live with that choice on a daily basis (unless they change their minds or unless their health status eliminates a treatment option). To further explore the lived experience for patients and their families after the medical treatment decision is made, four narratives are presented which describe the keeping and breaking of social contracts embedded in the social institutions of parenthood, marriage, family, and medicine. From hermeneutic analysis of narratives of end stage renal disease patients who must choose between life long dialysis therapy or transplantation, three patterns emerge: great expectations, broken promises, and true miracles.
Notes: Source: Dissertation Abstracts International, Volume: 57-01, Section: A, page: 0466.

Thesis (PH.D.)--UNIVERSITY OF KENTUCKY, 1996.

School code: 0102.