Table 2.

Psychosocial and communication barriers

Unawareness of option of supportive care

Nonacceptance of other option

Consider withdrawal as death

Consider withdrawal “giving up”

Fear related to society’s acceptance

Unrealistic hope about medical condition and prognosis

Lack of decision-making capacity in patient

Fear of outcome on family

Unaccomplished family needs

Financial burden on family

Fear that withdrawal causes destruction of hope

Health care provide factors

Difficulty in estimating patient’s prognosis

Lack of communication regarding patient’s wishes

Unrealistic expectations about prognosis

Inability to communicate the option of supportive care

Unavailability of trained palliative care/renal supportive care team

Ethical/legal difficulties to withdrawal

Acute presentations to ED

ED: Emergency department