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Patients with end-stage renal disease (ESRD) often face complex decisions regarding renal replacement therapy. Although previous studies have extensively explored factors influencing treatment choices, the treatment decision-making process and patients' experiences remain poorly understood.
The study aimed to explore treatment decision-making in patients with end-stage renal disease to inform the development of a patient journey map.
A descriptive qualitative study was conducted.
Purposive sampling with maximum variation was used to recruit 14 patients with end-stage renal disease to participate in face-to-face semi-structured interviews. Data were analysed using an inductive approach. Based on the interview data, a patient journey map was developed and refined through iterative team discussions.
Patients with end-stage renal disease experienced a treatment trajectory consisting of three stages: screening and diagnosis, renal replacement therapy decision-making, and ongoing treatment. Four dimensions—tasks, touchpoints, emotions, and pain points—were used to identify 19 themes, reflecting patients' behavioural patterns, emotional experiences, and key challenges across different stages. Patients commonly experienced limited access to information, insufficient support systems, and inadequate decision readiness during the treatment decision-making process. Most participants experienced decisional conflict and relied primarily on healthcare professionals to make decisions. As treatment progressed, patients' adaptability improved, but difficulties in complication management and insufficient informational needs remained.
The developed patient journey map demonstrates the cognitive, emotional, and behavioural patterns involved in clinical treatment decision-making among patients with end-stage renal disease and provides a framework for clinical practice to address patient needs more effectively.
Patients participated as interviewees during data collection. No patients or members of the public were involved in the study design, data analysis, or interpretation of the findings.
This study provides insight into the treatment decision-making experiences of patients with end-stage renal disease. The findings provide a framework for healthcare professionals to guide stage-specific interventions, decision-making, and patient engagement in renal replacement therapy.
Standards for Reporting Qualitative Research (SRQR).
Patients undergoing orotracheal intubation (OTI) are prone to oral mucosal pressure injuries (OMPI), yet clinical recognition and prevention remain insufficient. The knowledge, attitudes and practices (KAP) of ICU nurses regarding OMPI prevention are unclear, particularly in multicentre settings.
To assess ICU nurses' KAP on OMPI prevention in Western China, identify gaps, and inform targeted training and practices.
Cross-sectional survey.
A multicentre cross-sectional survey used convenience sampling. ICU nurses completed a 36-item KAP-OMPI questionnaire online. Data were analysed using R 4.3.3 and Zstats 1.0. Cronbach's α assessed internal consistency. Group comparisons used chi-square, Mann–Whitney U or Kruskal–Wallis tests (α = 0.05). Multivariate linear regression and mediation analysis (1000 bootstraps) tested the KAP pathway.
A total of 667 questionnaires were returned from ICU nurses in 48 hospitals. Median total KAP-OMPI score was 136. Knowledge scored 30, attitude 40 and practice 64. Univariate analysis showed that education, professional title, age, years of experience, prior OMPI care, training and active literature learning were significantly associated with all scores (all p < 0.05). Multivariate regression identified lack of training, no prior OMPI care and no active literature learning as independent predictors of lower total, knowledge and practice scores (all p < 0.05). Mediation analysis showed attitude partially mediated the knowledge–practice relationship (indirect effect 0.294), accounting for 31.35% of the total effect.
ICU nurses showed positive attitudes and moderate-to-high practices, but knowledge, assessment and evidence-based learning gaps persist. We recommend targeted training on staging and standardized protocols to improve OMPI prevention and reduce OTI-related complications.
Leveraging these findings, OMPI staging training and standardized protocols should be implemented to bridge the KAP gap and reduce intubation-related OMPI.
No patient or public involvement; data from anonymous nurse surveys only.
Chinese Clinical Trial Registry: ChiCTR2500112798 (Date: November 19, 2025)
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