Mrs Virginia Ocampo1
1Melbourne Health, Yarraville,3013, Australia
Biography:
I have been working for Melbourne Health for the last 34 years, currently as an Associate Nurse Unit Manager in the Acute Haemodialysis Unit. I love working in our unit, no two days are alike. The dynamic workflow makes your mind and body active. You get to know patients and their significant others. You get to hold patients hands in their most vulnerable times and get to celebrate their slightest wins. I find it very rewarding how we are in a position to influence patients health journey. These experiences cement the camaraderie and strong culture in our unit.
Abstract:
Background
Patients commencing chronic haemodialysis usually begin treatment within an acute dialysis unit, where adherence to prescribed therapy enables stabilisation and safe transition to satellite care. Most patients comply with recommended dialysis prescriptions, a small number deliberately or unintentionally refuse key aspects of treatment. Contributing factors include substance use, mental health challenges, treatment burden, pain, or limited understanding of risks.
Case description
These case studies highlight two patients who persistently declined recommended care despite extensive multidisciplinary support. Case 1: A patient accepted only twice-weekly dialysis for 3 hours via single-needle access, citing cannulation pain. Although a correctable AVF stenosis could have improved her experience and adequacy, she repeatedly refused intervention and remained poorly dialysed. Case 2: Another patient, symptomatic from anaemia, refused ESA and intravenous iron and restricted dialysis to 3 hours with low blood-flow rates on a small dialyser, resulting in inadequate clearance. Both cases involved repeated counselling by medical, nursing, and allied health staff without change in patient decisions.
Discussion
These scenarios underscore the tension between respecting patient autonomy and maintaining clinician duty of care. When patients refuse treatment, clinicians must ensure capacity assessment, provide clear risk–benefit explanations, explore modifiable barriers, document all discussions, and continue offering reasonable alternatives. Non-adherence does not end professional responsibility; however, the ultimate right to decline treatment remains with the patient.
Conclusion
These cases emphasise the need for individualised, compassionate, and legally sound approaches in managing refusal of medical advice in haemodialysis.