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One third of patients with chronic kidney disease receive information about treatment options after starting dialysis, contrary to current clinical guidelines For patients, lifestyle considerations rank higher than medical consequences of specific treatments in their decision making Thematic synthesis of qualitative studies is valuable in understanding patients' perspectives and can inform practice and policy The problematic timing of information about treatment options and synchronous creation of vascular access may predetermine the use of haemodialysis and limit choice of other treatments, including palliative care Patients have a strong preference for the status quo and are reluctant to change treatments, which may help explain why patients often continue with their initial therapy Cite this as: BMJ 2010;340:c112.

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