Skip to main content
Top
Published in:

Open Access 01-12-2022 | Acute Kidney Injury | Research

Bedside rationing and moral distress in nephrologists in sub- Saharan Africa

Authors: Gloria Ashuntantang, Ingrid Miljeteig, Valerie A. Luyckx

Published in: BMC Nephrology | Issue 1/2022

Login to get access

Abstract

Background

Kidney diseases constitute an important proportion of the non-communicable disease (NCD) burden in Sub-Saharan Africa (SSA), though prevention, diagnosis and treatment of kidney diseases are less prioritized in public health budgets than other high-burden NCDs. Dialysis is not considered cost-effective, and for those patients accessing the limited service available, high out-of-pocket expenses are common and few continue care over time. This study assessed challenges faced by nephrologists in SSA who manage patients needing dialysis. The specific focus was to investigate if and how physicians respond to bedside rationing situations.

Methods

A survey was conducted among a randomly selected group of nephrologists from SSA. The questionnaire was based on a previously validated survey instrument. A descriptive and narrative approach was used for analysis.

Results

Among 40 respondents, the majority saw patients weekly with acute kidney injury (AKI) or end-stage kidney failure (ESKF) in need of dialysis whom they could not dialyze. When dialysis was provided, clinical compromises were common, and 66% of nephrologists reported lack of basic diagnostics and medication and > 80% reported high out-of-pocket expenses for patients. Several patient-, disease- and institutional factors influenced who got access to dialysis. Patients’ financial constraints and poor chances of survival limited the likelihood of receiving dialysis (reported by 79 and 78% of nephrologists respectively), while a patient’s being the family bread-winner increased the likelihood (reported by 56%). Patient and institutional constraints resulted in most nephrologists (88%) frequently having to make difficult choices, sometimes having to choose between patients. Few reported existence of priority setting guidelines. Most nephrologists (74%) always, often or sometimes felt burdened by ethical dilemmas and worried about patients out of hospital hours. As a consequence, almost 46% of nephrologists reported frequently regretting their choice of profession and 26% had considered leaving the country.

Conclusion

Nephrologists in SSA face harsh priority setting at the bedside without available guidance. The moral distress is high. While publicly funded dialysis treatment might not be prioritized in essential health care packages on the path to universal health coverage, the suffering of the patients, families and the providers must be acknowledged and addressed to increase fairness in these decisions.
Appendix
Available only for authorised users
Literature
1.
go back to reference Kulish N. A Life and Death Battle: 4 Days of Kidney Failure but No Dialysis. New York: New York Times; 2020. Kulish N. A Life and Death Battle: 4 Days of Kidney Failure but No Dialysis. New York: New York Times; 2020.
2.
go back to reference Burgner A, Ikizler TA, Dwyer JP. COVID-19 and the inpatient Dialysis unit: managing resources during contingency planning pre-crisis. Clin J Am Soc Nephrol. 2020;15(5):720–2.PubMedPubMedCentralCrossRef Burgner A, Ikizler TA, Dwyer JP. COVID-19 and the inpatient Dialysis unit: managing resources during contingency planning pre-crisis. Clin J Am Soc Nephrol. 2020;15(5):720–2.PubMedPubMedCentralCrossRef
3.
go back to reference Jöbges S, Vinay R, Luyckx VA, Biller-Andorno N. Recommendations on COVID-19 triage: international comparison and ethical analysis. Bioethics. 2020;34(9):948–59.PubMedCrossRef Jöbges S, Vinay R, Luyckx VA, Biller-Andorno N. Recommendations on COVID-19 triage: international comparison and ethical analysis. Bioethics. 2020;34(9):948–59.PubMedCrossRef
4.
go back to reference Butler CR, Wong SPY, Wightman AG, O'Hare AM. US Clinicians' experiences and perspectives on resource limitation and patient care during the COVID-19 pandemic. JAMA Netw Open. 2020;3(11):e2027315.PubMedPubMedCentralCrossRef Butler CR, Wong SPY, Wightman AG, O'Hare AM. US Clinicians' experiences and perspectives on resource limitation and patient care during the COVID-19 pandemic. JAMA Netw Open. 2020;3(11):e2027315.PubMedPubMedCentralCrossRef
5.
go back to reference Kapiriri L, Martin DK. Priority setting in developing countries health care institutions: the case of a Ugandan hospital. BMC Health Serv Res. 2006;6:127.PubMedPubMedCentralCrossRef Kapiriri L, Martin DK. Priority setting in developing countries health care institutions: the case of a Ugandan hospital. BMC Health Serv Res. 2006;6:127.PubMedPubMedCentralCrossRef
6.
go back to reference Defaye FB, Desalegn D, Danis M, Hurst S, Berhane Y, Norheim OF, et al. A survey of Ethiopian physicians' experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences. BMC Health Serv Res. 2015;15:467.PubMedPubMedCentralCrossRef Defaye FB, Desalegn D, Danis M, Hurst S, Berhane Y, Norheim OF, et al. A survey of Ethiopian physicians' experiences of bedside rationing: extensive resource scarcity, tough decisions and adverse consequences. BMC Health Serv Res. 2015;15:467.PubMedPubMedCentralCrossRef
7.
go back to reference Strech D, Synofzik M, Marckmann G. How physicians allocate scarce resources at the bedside: a systematic review of qualitative studies. J Med Philos. 2008;33(1):80–99.PubMedCrossRef Strech D, Synofzik M, Marckmann G. How physicians allocate scarce resources at the bedside: a systematic review of qualitative studies. J Med Philos. 2008;33(1):80–99.PubMedCrossRef
8.
go back to reference Moosa MR, Luyckx VA. The realities of rationing in health care. Nat Rev Nephrol. 2021;17(7):435–6.PubMedCrossRef Moosa MR, Luyckx VA. The realities of rationing in health care. Nat Rev Nephrol. 2021;17(7):435–6.PubMedCrossRef
10.
go back to reference International Society of Nephrology: Global Kidney Health Atlas: A report by the International Society of Nephrology on the Global Burden of End-stage Kidney Disease and Capacity for Kidney Replacement Therapy and Conservative Care across World Countries and Regions. In. Edited by Nephrology ISo, 2 edn. Brussels, Belgium; 2019. International Society of Nephrology: Global Kidney Health Atlas: A report by the International Society of Nephrology on the Global Burden of End-stage Kidney Disease and Capacity for Kidney Replacement Therapy and Conservative Care across World Countries and Regions. In. Edited by Nephrology ISo, 2 edn. Brussels, Belgium; 2019.
11.
go back to reference Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet Glob Health. 2019;7(10):e1295–6.PubMedCrossRef Bigna JJ, Noubiap JJ. The rising burden of non-communicable diseases in sub-Saharan Africa. Lancet Glob Health. 2019;7(10):e1295–6.PubMedCrossRef
12.
go back to reference George JA, Brandenburg JT, Fabian J, Crowther NJ, Agongo G, Alberts M, et al. Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-gen): a cross-sectional population study. Lancet Glob Health. 2019;7(12):e1632–43.PubMedPubMedCentralCrossRef George JA, Brandenburg JT, Fabian J, Crowther NJ, Agongo G, Alberts M, et al. Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-gen): a cross-sectional population study. Lancet Glob Health. 2019;7(12):e1632–43.PubMedPubMedCentralCrossRef
13.
go back to reference Tesema AG, Ajisegiri WS, Abimbola S, Balane C, Kengne AP, Shiferaw F, et al. How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization's African regional targets. PLoS One. 2020;15(10):e0240984.PubMedPubMedCentralCrossRef Tesema AG, Ajisegiri WS, Abimbola S, Balane C, Kengne AP, Shiferaw F, et al. How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization's African regional targets. PLoS One. 2020;15(10):e0240984.PubMedPubMedCentralCrossRef
15.
go back to reference Crosby L, Baker P, Hangoma P, Barasa E, Hamidi V, Chalkidou K. Dialysis in Africa: the need for evidence-informed decision making. Lancet Glob Health. 2020;8(4):e476–7.PubMedCrossRef Crosby L, Baker P, Hangoma P, Barasa E, Hamidi V, Chalkidou K. Dialysis in Africa: the need for evidence-informed decision making. Lancet Glob Health. 2020;8(4):e476–7.PubMedCrossRef
16.
go back to reference Ashuntantang G, Osafo C, Olowu WA, Arogundade F, Niang A, Porter J, et al. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2017;5(4):e408–17.PubMedCrossRef Ashuntantang G, Osafo C, Olowu WA, Arogundade F, Niang A, Porter J, et al. Outcomes in adults and children with end-stage kidney disease requiring dialysis in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2017;5(4):e408–17.PubMedCrossRef
17.
go back to reference Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2016;4(4):e242–50.PubMedCrossRef Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2016;4(4):e242–50.PubMedCrossRef
18.
go back to reference Dodd R, Palagyi A, Guild L, Jha V, Jan S. The impact of out-of-pocket costs on treatment commencement and adherence in chronic kidney disease: a systematic review. Health Policy Plan. 2018;33(9):1047–54.PubMedCrossRef Dodd R, Palagyi A, Guild L, Jha V, Jan S. The impact of out-of-pocket costs on treatment commencement and adherence in chronic kidney disease: a systematic review. Health Policy Plan. 2018;33(9):1047–54.PubMedCrossRef
19.
go back to reference Moosa MR, Wearne N. Invited commentary should we be rationing Dialysis in South Africa in the 21(st) century? Perit Dial Int. 2018;38(2):84–8.PubMedCrossRef Moosa MR, Wearne N. Invited commentary should we be rationing Dialysis in South Africa in the 21(st) century? Perit Dial Int. 2018;38(2):84–8.PubMedCrossRef
20.
go back to reference Wearne N, Davidson B, Motsohi T, Mc Culloch M, Krause R. Radically rethinking renal supportive and palliative Care in South Africa. Kidney Int Rep. 2021;6(3):568–73.PubMedCrossRef Wearne N, Davidson B, Motsohi T, Mc Culloch M, Krause R. Radically rethinking renal supportive and palliative Care in South Africa. Kidney Int Rep. 2021;6(3):568–73.PubMedCrossRef
21.
22.
go back to reference Luyckx VA, Moosa MR. Priority setting as an ethical imperative in managing global Dialysis access and improving kidney care. Semin Nephrol. 2021;41(3):230–41.PubMedCrossRef Luyckx VA, Moosa MR. Priority setting as an ethical imperative in managing global Dialysis access and improving kidney care. Semin Nephrol. 2021;41(3):230–41.PubMedCrossRef
23.
go back to reference Voorhoeve A, Tan-Torres Edejer T, Kapiriri L, Norheim OF, Snowden J, Basenya O, et al. Making fair choices on the path to universal health coverage: applying principles to difficult cases. Health Syst Reform. 2017;3(4):301–12.PubMedCrossRef Voorhoeve A, Tan-Torres Edejer T, Kapiriri L, Norheim OF, Snowden J, Basenya O, et al. Making fair choices on the path to universal health coverage: applying principles to difficult cases. Health Syst Reform. 2017;3(4):301–12.PubMedCrossRef
25.
go back to reference Chuengsaman P, Kasemsup V. PD first policy: Thailand's response to the challenge of meeting the needs of patients with end-stage renal disease. Semin Nephrol. 2017;37(3):287–95.PubMedCrossRef Chuengsaman P, Kasemsup V. PD first policy: Thailand's response to the challenge of meeting the needs of patients with end-stage renal disease. Semin Nephrol. 2017;37(3):287–95.PubMedCrossRef
26.
go back to reference McIntyre D, Ranson MK, Aulakh BK, Honda A. Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress. Health Res Policy Syst. 2013;11:36.PubMedPubMedCentralCrossRef McIntyre D, Ranson MK, Aulakh BK, Honda A. Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress. Health Res Policy Syst. 2013;11:36.PubMedPubMedCentralCrossRef
27.
go back to reference Flood D, Wilcox K, Ferro AA, Mendoza Montano C, Barnoya J, Garcia P, et al. Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals. BMC Nephrol. 2020;21(1):71.PubMedPubMedCentralCrossRef Flood D, Wilcox K, Ferro AA, Mendoza Montano C, Barnoya J, Garcia P, et al. Challenges in the provision of kidney care at the largest public nephrology center in Guatemala: a qualitative study with health professionals. BMC Nephrol. 2020;21(1):71.PubMedPubMedCentralCrossRef
28.
go back to reference Shekhani SS, Lanewala AA. Ethical challenges in Dialysis and transplantation: perspectives from the developing world. Semin Nephrol. 2021;41(3):211–9.PubMedCrossRef Shekhani SS, Lanewala AA. Ethical challenges in Dialysis and transplantation: perspectives from the developing world. Semin Nephrol. 2021;41(3):211–9.PubMedCrossRef
29.
go back to reference Persad GC, Emanuel EJ. The ethics of expanding access to cheaper, less effective treatments. Lancet. 2016;388(10047):932–4.PubMedCrossRef Persad GC, Emanuel EJ. The ethics of expanding access to cheaper, less effective treatments. Lancet. 2016;388(10047):932–4.PubMedCrossRef
30.
go back to reference Miljeteig I, Defaye FB, Wakim P, Desalegn DN, Berhane Y, Norheim OF, et al. Financial risk protection at the bedside: how Ethiopian physicians try to minimize out-of-pocket health expenditures. PLoS One. 2019;14(2):e0212129.PubMedPubMedCentralCrossRef Miljeteig I, Defaye FB, Wakim P, Desalegn DN, Berhane Y, Norheim OF, et al. Financial risk protection at the bedside: how Ethiopian physicians try to minimize out-of-pocket health expenditures. PLoS One. 2019;14(2):e0212129.PubMedPubMedCentralCrossRef
31.
go back to reference Luyckx VA, Miljeteig I, Ejigu AM, Moosa MR. Ethical challenges in the provision of Dialysis in resource-constrained environments. Semin Nephrol. 2017;37(3):273–86.PubMedCrossRef Luyckx VA, Miljeteig I, Ejigu AM, Moosa MR. Ethical challenges in the provision of Dialysis in resource-constrained environments. Semin Nephrol. 2017;37(3):273–86.PubMedCrossRef
32.
go back to reference Dreyer G, Dobbie H, Banks R, Allain T, Gonani A, Turner N, et al. Supporting Malawi's dialysis services with the international community. Br J Renal Med. 2012;17(2):24–6. Dreyer G, Dobbie H, Banks R, Allain T, Gonani A, Turner N, et al. Supporting Malawi's dialysis services with the international community. Br J Renal Med. 2012;17(2):24–6.
33.
go back to reference Paltiel O, Berhe E, Aberha AH, Tequare MH, Balabanova D. A public-private partnership for dialysis provision in Ethiopia: a model for high-cost care in low-resource settings. Health Policy Plan. 2020;35(9):1262–7.PubMedCrossRef Paltiel O, Berhe E, Aberha AH, Tequare MH, Balabanova D. A public-private partnership for dialysis provision in Ethiopia: a model for high-cost care in low-resource settings. Health Policy Plan. 2020;35(9):1262–7.PubMedCrossRef
34.
go back to reference Okungu V, Chuma J, McIntyre D. The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms. Int J Equity Health. 2017;16(1):39.PubMedPubMedCentralCrossRef Okungu V, Chuma J, McIntyre D. The cost of free health care for all Kenyans: assessing the financial sustainability of contributory and non-contributory financing mechanisms. Int J Equity Health. 2017;16(1):39.PubMedPubMedCentralCrossRef
35.
go back to reference Nde CJ, Raymond A, Saidu Y, Cheng NI, Nzuobontane D, Atemnkeng JT, et al. Reaching universal health coverage by 2035: is Cameroon on track? Unv J Publ Health. 2019;7(3):110–7. Nde CJ, Raymond A, Saidu Y, Cheng NI, Nzuobontane D, Atemnkeng JT, et al. Reaching universal health coverage by 2035: is Cameroon on track? Unv J Publ Health. 2019;7(3):110–7.
37.
go back to reference Etheredge H, Fabian J. Challenges in expanding access to dialysis in South Africa-expensive modalities, cost constraints and human rights. Healthcare (Basel). 2017;5(3):38.CrossRef Etheredge H, Fabian J. Challenges in expanding access to dialysis in South Africa-expensive modalities, cost constraints and human rights. Healthcare (Basel). 2017;5(3):38.CrossRef
38.
go back to reference Gibson D. The liminality of kidney failure in south African state hospitals. Anthropol S Afr. 2011;34(1&2):74–81. Gibson D. The liminality of kidney failure in south African state hospitals. Anthropol S Afr. 2011;34(1&2):74–81.
39.
go back to reference Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020;382(21):2049–55.PubMedCrossRef Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020;382(21):2049–55.PubMedCrossRef
40.
go back to reference Norheim OF. Healthcare rationing-are additional criteria needed for assessing evidence based clinical practice guidelines? BMJ (Clinical research ed). 1999;319(7222):1426–9.CrossRef Norheim OF. Healthcare rationing-are additional criteria needed for assessing evidence based clinical practice guidelines? BMJ (Clinical research ed). 1999;319(7222):1426–9.CrossRef
41.
go back to reference Essue BM, Laba TL, Knaul F, Chu A, Minh HV, Nguyen TKP, et al. Economic burden of chronic ill health and injuries for households in low- and middle-income countries. In: Jamison DT, Gelband H, Horton S, Jha P, Laxminarayan R, Mock C, Nugent R, editors. Disease control priorities improving health and reducing poverty,. Volume 9. 3rd ed. Washington: World Bank; 2018. p. 121–43. Essue BM, Laba TL, Knaul F, Chu A, Minh HV, Nguyen TKP, et al. Economic burden of chronic ill health and injuries for households in low- and middle-income countries. In: Jamison DT, Gelband H, Horton S, Jha P, Laxminarayan R, Mock C, Nugent R, editors. Disease control priorities improving health and reducing poverty,. Volume 9. 3rd ed. Washington: World Bank; 2018. p. 121–43.
42.
go back to reference Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, et al. Action to address the household economic burden of non-communicable diseases. Lancet. 2018;391(10134):2047–58.PubMedCrossRef Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, et al. Action to address the household economic burden of non-communicable diseases. Lancet. 2018;391(10134):2047–58.PubMedCrossRef
43.
go back to reference Bello A, Sangweni B, Mudi A, Khumalo T, Moonsamy G, Levy C. The financial cost incurred by families of children on long-term Dialysis. Perit Dial Int. 2018;38(1):14–7.PubMedCrossRef Bello A, Sangweni B, Mudi A, Khumalo T, Moonsamy G, Levy C. The financial cost incurred by families of children on long-term Dialysis. Perit Dial Int. 2018;38(1):14–7.PubMedCrossRef
44.
go back to reference Savla D, Chertow GM, Meyer T, Anand S. Can twice weekly hemodialysis expand patient access under resource constraints? Hemodial Int. 2017;21(4):445–52.PubMedCrossRef Savla D, Chertow GM, Meyer T, Anand S. Can twice weekly hemodialysis expand patient access under resource constraints? Hemodial Int. 2017;21(4):445–52.PubMedCrossRef
45.
go back to reference Kaze FF, Ashuntantang G, Kengne AP, Hassan A, Halle MP, Muna W. Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced sub-Saharan African health systems. Hemodial Int. 2012;16(4):526–31.PubMedCrossRef Kaze FF, Ashuntantang G, Kengne AP, Hassan A, Halle MP, Muna W. Acute hemodialysis complications in end-stage renal disease patients: the burden and implications for the under-resourced sub-Saharan African health systems. Hemodial Int. 2012;16(4):526–31.PubMedCrossRef
46.
go back to reference Norheim OF, Baltussen R, Johri M, Chisholm D, Nord E, Brock D, et al. Guidance on priority setting in health care (GPS-health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc. 2014;12:18.PubMedPubMedCentralCrossRef Norheim OF, Baltussen R, Johri M, Chisholm D, Nord E, Brock D, et al. Guidance on priority setting in health care (GPS-health): the inclusion of equity criteria not captured by cost-effectiveness analysis. Cost Eff Resour Alloc. 2014;12:18.PubMedPubMedCentralCrossRef
47.
go back to reference Husoy OK, Molla SM, Muluken G, Marie MK, Frithof NO, Ingrid M. Selling my sheep to pay for medicines - household priorities and coping strategies in a setting without universal health coverage. BMC Health Serv Res. 2018;18(1):153.PubMedCentralCrossRef Husoy OK, Molla SM, Muluken G, Marie MK, Frithof NO, Ingrid M. Selling my sheep to pay for medicines - household priorities and coping strategies in a setting without universal health coverage. BMC Health Serv Res. 2018;18(1):153.PubMedCentralCrossRef
48.
go back to reference Ulasi I. Gender bias in access to healthcare in Nigeria: a study of end-stage renal disease. Trop Dr. 2008;38(1):50–2. Ulasi I. Gender bias in access to healthcare in Nigeria: a study of end-stage renal disease. Trop Dr. 2008;38(1):50–2.
49.
go back to reference Ackoundou-N'Guessan C, Hoang AD, Ben Abdallah T, Gnionsahe DA, Dollo I, Ripoche C, et al. Living kidney donor transplantation in a resource-limited country: the Ivory Coast experience. Transplant Proc. 2015;47(6):1580–4.PubMedCrossRef Ackoundou-N'Guessan C, Hoang AD, Ben Abdallah T, Gnionsahe DA, Dollo I, Ripoche C, et al. Living kidney donor transplantation in a resource-limited country: the Ivory Coast experience. Transplant Proc. 2015;47(6):1580–4.PubMedCrossRef
50.
go back to reference Kapiriri L, Norheim OF. Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values. Bull World Health Organ. 2004;82(3):172–9.PubMedPubMedCentral Kapiriri L, Norheim OF. Criteria for priority-setting in health care in Uganda: exploration of stakeholders' values. Bull World Health Organ. 2004;82(3):172–9.PubMedPubMedCentral
51.
go back to reference Wearne N, Kilonzo K, Effa E, Davidson B, Nourse P, Ekrikpo U, et al. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries. Int J Nephrol Renov Dis. 2017;10:1–9.CrossRef Wearne N, Kilonzo K, Effa E, Davidson B, Nourse P, Ekrikpo U, et al. Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries. Int J Nephrol Renov Dis. 2017;10:1–9.CrossRef
52.
go back to reference Niang A, Iyengar A, Luyckx VA. Hemodialysis versus peritoneal dialysis in resource-limited settings. Curr Opin Nephrol Hypertens. 2018;27(6):463–71.PubMedCrossRef Niang A, Iyengar A, Luyckx VA. Hemodialysis versus peritoneal dialysis in resource-limited settings. Curr Opin Nephrol Hypertens. 2018;27(6):463–71.PubMedCrossRef
53.
54.
go back to reference Morley G, Ives J, Bradbury-Jones C, Irvine F. What is 'moral distress'? A narrative synthesis of the literature. Nurs Ethics. 2019;26(3):646–62.PubMedCrossRef Morley G, Ives J, Bradbury-Jones C, Irvine F. What is 'moral distress'? A narrative synthesis of the literature. Nurs Ethics. 2019;26(3):646–62.PubMedCrossRef
55.
go back to reference Monteverde S. Komplexität, Komplizität und moralischer Stress in der Pflege. Ethik in der Medizin. 2019;31(4):345–60.CrossRef Monteverde S. Komplexität, Komplizität und moralischer Stress in der Pflege. Ethik in der Medizin. 2019;31(4):345–60.CrossRef
56.
go back to reference Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol. 2017;22(1):51–67.PubMedCrossRef Lamiani G, Borghi L, Argentero P. When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. J Health Psychol. 2017;22(1):51–67.PubMedCrossRef
57.
go back to reference Ducharlet K, Trivedi M, Gelfand SL, Liew H, McMahon LP, Ashuntantang G, et al. Moral distress and moral injury in nephrology during the COVID-19 pandemic. Semin Nephrol. 2021;41(3):253–61.PubMedPubMedCentralCrossRef Ducharlet K, Trivedi M, Gelfand SL, Liew H, McMahon LP, Ashuntantang G, et al. Moral distress and moral injury in nephrology during the COVID-19 pandemic. Semin Nephrol. 2021;41(3):253–61.PubMedPubMedCentralCrossRef
58.
go back to reference Mobolaji-Olajide OM, Amira OC, Ademuyiwa IY, Arogundade FA, Duke E. The burden of caring for renal patients: the nurses perspective. Saudi J Kidney Dis Transpl. 2018;29(4):916–23.PubMedCrossRef Mobolaji-Olajide OM, Amira OC, Ademuyiwa IY, Arogundade FA, Duke E. The burden of caring for renal patients: the nurses perspective. Saudi J Kidney Dis Transpl. 2018;29(4):916–23.PubMedCrossRef
59.
go back to reference Giannetta N, Villa G, Pennestri F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int J Nurs Stud. 2020;111:103767.PubMedCrossRef Giannetta N, Villa G, Pennestri F, Sala R, Mordacci R, Manara DF. Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties. Int J Nurs Stud. 2020;111:103767.PubMedCrossRef
60.
go back to reference Argentero P, Dell'Olivo B, Ferretti MS. Staff burnout and patient satisfaction with the quality of dialysis care. Am J Kidney Dis. 2008;51(1):80–92.PubMedCrossRef Argentero P, Dell'Olivo B, Ferretti MS. Staff burnout and patient satisfaction with the quality of dialysis care. Am J Kidney Dis. 2008;51(1):80–92.PubMedCrossRef
61.
go back to reference Dyrbye LN, Burke SE, Hardeman RR, Herrin J, Wittlin NM, Yeazel M, et al. Association of Clinical Specialty with Symptoms of burnout and career choice regret among US resident physicians. Jama. 2018;320(11):1114–30.PubMedPubMedCentralCrossRef Dyrbye LN, Burke SE, Hardeman RR, Herrin J, Wittlin NM, Yeazel M, et al. Association of Clinical Specialty with Symptoms of burnout and career choice regret among US resident physicians. Jama. 2018;320(11):1114–30.PubMedPubMedCentralCrossRef
63.
go back to reference Moosa MR, Maree JD, Chirehwa MT, Benatar SR. Use of the 'Accountability for Reasonableness' approach to improve fairness in accessing Dialysis in a middle-income country. PLoS One. 2016;11(10):e0164201.PubMedPubMedCentralCrossRef Moosa MR, Maree JD, Chirehwa MT, Benatar SR. Use of the 'Accountability for Reasonableness' approach to improve fairness in accessing Dialysis in a middle-income country. PLoS One. 2016;11(10):e0164201.PubMedPubMedCentralCrossRef
64.
go back to reference Hurst SA, Danis M. A framework for rationing by clinical judgment. Kennedy Inst Ethics J. 2007;17(3):247–66.PubMedCrossRef Hurst SA, Danis M. A framework for rationing by clinical judgment. Kennedy Inst Ethics J. 2007;17(3):247–66.PubMedCrossRef
65.
go back to reference Owen-Smith A, Coast J, Donovan J. The desirability of being open about health care rationing decisions: findings from a qualitative study of patients and clinical professionals. J Health Serv Res Policy. 2010;15(1):14–20.PubMedCrossRef Owen-Smith A, Coast J, Donovan J. The desirability of being open about health care rationing decisions: findings from a qualitative study of patients and clinical professionals. J Health Serv Res Policy. 2010;15(1):14–20.PubMedCrossRef
Metadata
Title
Bedside rationing and moral distress in nephrologists in sub- Saharan Africa
Authors
Gloria Ashuntantang
Ingrid Miljeteig
Valerie A. Luyckx
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-022-02827-2

Other articles of this Issue 1/2022

BMC Nephrology 1/2022 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Webinar | 06-02-2024 | 20:00 (CET)

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by: Viatris

Developed by: Springer Healthcare
Live Webinar | 01-10-2024 | 12:30 (CEST)

Recent advances in the use of CAR T-cell therapies in relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma

Live: Tuesday 1st October 2024, 12:30-14:00 (CEST)

In this live webinar, Professor Martin Dreyling and an esteemed, international panel of CAR-T experts will discuss the very latest data on the safety, efficacy and clinical impact of CAR T-cell therapies in the treatment of r/r DLBCL and r/r FL, as presented at ASH 2023, EU CAR-T 2024, and EHA 2024. 

Please note, this webinar is not intended for healthcare professionals based in the US and UK.

Sponsored by: Novartis Pharma AG

Chaired by: Prof. Martin Dreyling
Developed by: Springer Healthcare