Maniam, Radha, Maw Pin Tan, & Mei Chan Chong (2021, September). End of life care preference among hemodialysis population: Revisit Q methodology. Patient Education and Counseling. (ePub in advance of print) (Link:

Abstract: Objective: End-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population. Methods: The Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation. Results: Forty-three persons living with haemodialysis, mean age ± SD= 56.58 ±10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated. Conclusions: End-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies. Practice implications: Statement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.

Radha Maniam <> is in the Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.