Determinants of dialysis modality choice in end-stage chronic kidney disease ::patient and healthcare professional perspectives

Background: Chronic kidney disease (CKD) affects 8–16% of the global population and can progress to a stage requiring renal replacement therapy. While transplantation is the preferred treatment, when not immediately possible, patients must initiate dialysis. Several modalities exist (peritoneal dialysis, in-center, self-care, or home-based hemodialysis). How patients and professionals navigate this choice has been poorly studied in Switzerland. Objective: To investigate how dialysis modality choices are made, and which factors influence the decision in the French-speaking part of Switzerland, from both patients’ and healthcare professionals’ perspectives. Methods: A qualitative study was conducted in eight dialysis centers. Semi-structured interviews were recorded, transcribed, and thematically analyzed. Participants included 25 patients (mean age 61, SD 14; 72% men), five nurses, and seven nephrologists. Results: Five themes emerged, largely consistent across patients and professionals:1. Crisis-driven decision-making: Patients and healthcare professionals viewed modality choice as a process, but patients often experienced the moment of the decision as urgent, triggered by unbearable symptoms. They described four emotional stages (diagnosis shock, distancing from the silent disease, shock of impending dialysis, constrained acceptance).2.Autonomy vs. safety: Choices were shaped by self-efficacy, family involvement, and trust in professionals.3.Personal and social life alignment: Compatibility with work, routines, family dynamics, social engagement, and culture strongly influenced preferences.4.Shared decision-making and ownership: Patients reported “owning” the decision, though families and professionals were key partners.5.System-level influences: Medical contraindications, policies, economic incentives, and logistical constraints (e.g., storage space, transport) framed the options available. Conclusions: When modalities are equally accessible, decisions are not driven by cost but by psychological readiness, perceived safety, and lifestyle compatibility. Despite comprehensive patient education, emotional preparedness was less emphasized. As patients frequently perceived they made their choice under crisis, early psychological support and system-level adaptations are needed to strengthen person-centered care.