Article Text

Original research
‘You see the empty bed which means it’s either a transplant or a death’: a qualitative study exploring the impact of death in the haemodialysis community
  1. Sheera Sutherland1,
  2. Kirsty E Durley2,
  3. Kirsty Gillies1,
  4. Margaret Glogowska3,
  5. Daniel S Lasserson4,
  6. Christopher Pugh1,5,
  7. Aoife C Lowney2
  1. 1Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2Department of Palliative Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  4. 4Population Evidence and Technologies, Warwick Medical School, University of Warwick, Coventry, UK
  5. 5Nuffield Department of Clinical Medicine, University of Oxford, Oxford, Oxfordshire, UK
  1. Correspondence to Sheera Sutherland; Sheera.Sutherland{at}


Objective To explore the impact of the death of a patient in the haemodialysis unit on fellow patients.

Methods We interviewed patients on dialysis in a tertiary dialysis centre using semistructured interviews. We purposively sampled patients who had experienced the death of a fellow patient. After interviews were transcribed, they were thematically analysed by independent members of the research team using inductive analysis. Input from the team during analysis ensured the rigour and quality of the findings.

Results 10 participants completed the interviews (6 females and 4 males with an age range of 42–88 years). The four core themes that emerged from the interviews included: (1) patients’ relationship to haemodialysis, (2) how patients define the haemodialysis community, (3) patients’ views on death and bereavement and (4) patients’ expectations around death in the dialysis community. Patients noticed avoidance behaviour by staff in relation to discussing death in the unit and would prefer a culture of open acknowledgement.

Conclusion Staff acknowledgement of death is of central importance to patients on haemodialysis who feel that the staff are part of their community. This should guide the development of appropriate bereavement support services and a framework that promotes the provision of guidance for staff and patients in this unique clinical setting. However, the authors acknowledge the homogenous sample recruited in a single setting may limit the transferability of the study. Further work is needed to understand diverse patient and nurse experiences and perceptions when sharing the knowledge of a patient’s death and how they react to loss.

  • adult palliative care
  • dialysis
  • end stage renal failure

Data availability statement

Data are available upon reasonable request. Data are available by emailing Sheera Sutherland at

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

Data are available upon reasonable request. Data are available by emailing Sheera Sutherland at

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  • CP and ACL are joint senior authors.

  • Contributors KG, CP, MG and DSL were involved in the design of the study. SS and KG collected the data. SS, MG and KED were involved in data analysis and interpretation. SS, KED, MG and ACL were involved in drafting the article. SS, KED, MG, DSL, ACL and CP involved in the critical revision of this manuscript. All authors read and approved the final manuscript.

  • Funding KG acknowledges the support and funding of an Oxfordshire Health Services Research Committee Grant (Fund Number 1189). DSL is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no involvement in the study design, data analysis and writing of the report or decision to publish.

  • Competing interests CP is chair of the Oxfordshire Health Services Research Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.