The Japanese Journal of Clinical Dialysis Vol.34 No.10(1-1)

Theme The management of the end of life in hemodialysis patients
Title Proposal for the Shared Decision -- Making Process Regarding Initiation and Continuation of Maintenance Hemodialysis -- its background and way of thinking
Publish Date 2018/09
Author Hideki Hirakata Fukuoka Renal Clinic
[ Summary ] In 2013, the Japanese Society for Dialysis Therapy presented the hemodialysis (HD) guidelines comprising 3 components: the initiation of HD for maintenance HD, prescriptions for HD, and the proposal for a shared decision-making process regarding initiation and continuation of maintenance HD. The basic policy outlined in the proposal is that medical decision-making should not be confined to a single physician but should involve interagency cooperation and coordination between members of a medical team to provide sufficient support and information to a patient, thereby enabling patients to make accurate and autonomous informed decisions. The proposal is not linked with health economics or aging issues. The terms withholding and withdrawal were consolidated into a single definition of 'forgoing'. Forgoing implies that HD can be initiated or re-initiated at any time, depending on the situation.
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