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Narratives of continuity among older people with late stage chronic kidney disease who decline dialysis.

Llewellyn, H; Low, J; Smith, G; Hopkins, K; Burns, A; Jones, L; (2014) Narratives of continuity among older people with late stage chronic kidney disease who decline dialysis. Soc Sci Med , 114 49 - 56. 10.1016/j.socscimed.2014.05.037. Green open access

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Abstract

Chronic and life-threatening conditions are widely thought to shatter the lives of those affected. In this article, we examine the accounts of 19 older people diagnosed with late stage chronic kidney disease who declined dialysis. Accounts were collected through in-depth interview in the United Kingdom (March-November, 2010). Drawing on a phenomenological approach, we focus particularly on the embodied and lived experience of the condition and on how participants constructed treatment modalities and approached treatment choice. We look toward contemporary elaborations of the conceptual framework of biographical disruption to illustrate how participants managed to contain the intrusion of illness and maintain continuity in their lives. We argue that three interactive phenomena mitigated the potential for disruption and allowed participants to maintain continuity: (a) the framing of illness as "old age"; (b) the prior experience of serious illness; and (c) the choice of the treatment with the least potential for disruption. We conclude that a diagnosis of chronic illness in late life does not inevitably shatter lives or engender biographical disruption. Instead, people are able to construct continuity owing to complex narrative interpretations of diagnosis, sensation and treatment choices.

Type: Article
Title: Narratives of continuity among older people with late stage chronic kidney disease who decline dialysis.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.socscimed.2014.05.037
Publisher version: http://dx.doi.org/10.1016/j.socscimed.2014.05.037
Language: English
Additional information: © 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).
Keywords: Aging, Biographical disruption, Chronic illness, Conservative care, Decision making, Kidney dialysis, Lived experience, United Kingdom, Aged, Aged, 80 and over, Attitude to Health, Choice Behavior, Female, Great Britain, Humans, Male, Narration, Qualitative Research, Renal Dialysis, Renal Insufficiency, Chronic, Treatment Refusal
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1432439
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