Patients with end-stage kidney disease receiving maintenance haemodialysis in mainland China often do not recognise advance care planning as a concrete decision about their future care, according to a qualitative study published in BMC Nephrology.
Three interrelated themes emerged from the analysis. The first was that advance care planning had not yet been recognised as a concrete future care decision. Participants had limited prior understanding of the concept and frequently associated it with treatment withdrawal or death. They needed clearer explanations of disease progression, resuscitation, haemodialysis continuation and the care options available to them, suggesting that generic information provision alone does not translate into meaningful decision support in this context.
The second theme concerned how dignity was understood. Participants said they would prefer comfort-oriented care if recovery became unlikely, valued a peaceful care environment, and linked their sense of dignity to avoiding unnecessary burden on family members.
The third theme described what effective decision support would need to look like: family-inclusive, clinician-facilitated and paced to each patient’s readiness. Family involvement provided emotional security and functioned as a decision partnership, while respectful communication from healthcare professionals helped patients move from avoidance toward conditional engagement with future care discussions.
The authors conclude that these patients need decision support that goes beyond general information provision. Advance care planning support should translate future care decisions into haemodialysis-specific contexts, address dignity in relation to comfort and family responsibility, and create opportunities for patients to express preferences within family-centred decision-making. Nurse-facilitated, team-based and culturally adapted decision aids may help integrate advance care planning into routine haemodialysis care.
Even so, the work addresses a recognised gap. Patients on maintenance haemodialysis face complex, recurring decisions about the continuation of life-sustaining treatment and end-of-life care, yet in mainland China these conversations are not routinely built into dialysis practice. By documenting how patients themselves frame dignity, family responsibility and readiness to engage, the study offers a concrete starting point for clinicians and researchers developing decision-support interventions suited to this cultural setting.
The study is open access and was published on 22 October 2026, with the article shared early under a citable pre-publication version carrying a permanent DOI pending the final Version of Record.
Subject of Research: Advance care planning decision-support needs among maintenance haemodialysis patients in mainland China
Article Title: Culturally contextualised advance care planning decision-support needs among patients receiving maintenance haemodialysis in mainland China: a qualitative study
Article References: You, T., Liu, J., Gou, Y., & Liu, M. (2026). Culturally contextualised advance care planning decision-support needs among patients receiving maintenance haemodialysis in mainland China: a qualitative study. BMC Nephrology. https://doi.org/10.1186/s12882-026-05434-7
Image Credits: AI Generated
DOI: 10.1186/s12882-026-05434-7
Keywords: advance care planning, end-stage kidney disease, maintenance haemodialysis, qualitative research, decision support, mainland China, end-of-life care, dignity, family-centred decision-making, nurse-facilitated, Ottawa Decision Support Framework, BMC Nephrology
News Source: Jerry Hayes. (October 29, 2026). Dialysis Patients in China Need Family-Centred Advance Care Planning Support. Scienmag.
