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Background <p>Chronic Kidney Disease affects 13% of China’s population, with hemodialysis consuming 1–3% of national healthcare expenditure. Hemodialysis patients face complex physical-psychological burdens, while physicians in Traditional Chinese Medicine (TCM) hospitals navigate unique ethical dilemmas arising from dual Western-TCM practice paradigms, cultural expectations, and systemic healthcare pressures. This study employed Social-Ecological Systems Theory to analyze these multilayered challenges and developed a structured ethical model.</p> Methods <p>This study followed a qualitative phenomenological research design. Maximum variation purposive sampling was employed to recruit 28 hemodialysis physicians from six TCM hospitals across five cities in Shandong Province, China. Data were collected through focus group and in-depth individual interviews with 28 hemodialysis physicians from November 2024 to January 2025, and were analyzed following Colaizzi’s descriptive analysis framework. The framework of the Society Ecosystems Theory was applied to analyze how multilevel systemic interactions shape ethical challenges, thereby constructing a multidimensional conceptual model.</p> Results <p>Ethical challenges encountered by hemodialysis physicians were categorized into three themes with seven subthemes and 17 subcategories. Based on these findings, a three-tiered model was developed: macro-system challenges involving policy, organizational, and cultural dimensions; meso-system challenges emerging from interprofessional dynamics, particularly doctor-doctor, doctor-nurse, and doctor-patient relationships; and micro-system challenges pertaining to individual difficulties.</p> Conclusion <p>The conceptual model reveals the multi-level nature of ethical challenges in hemodialysis practice, spanning systemic policies, interprofessional relationships, and individual dilemmas. The findings specifically call for targeted interventions at each level: policy reforms to address resource constraints, team-based strategies to improve clinical collaborations, and support systems to alleviate practitioners’ ethical distress. These evidence-based insights empower stakeholders to develop comprehensive solutions addressing the interconnected challenges identified.</p>

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A multidimensional model of ethical challenges in hemodialysis: a qualitative study for specialist physicians

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  • 出版模式：

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  • 发表日期：

    2025年10月21日

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  • Yuxiu Jia,
  • Bin Dong,
  • Yuehui Shi,
  • Farong Zhang

摘要

Background

Chronic Kidney Disease affects 13% of China’s population, with hemodialysis consuming 1–3% of national healthcare expenditure. Hemodialysis patients face complex physical-psychological burdens, while physicians in Traditional Chinese Medicine (TCM) hospitals navigate unique ethical dilemmas arising from dual Western-TCM practice paradigms, cultural expectations, and systemic healthcare pressures. This study employed Social-Ecological Systems Theory to analyze these multilayered challenges and developed a structured ethical model.

Methods

This study followed a qualitative phenomenological research design. Maximum variation purposive sampling was employed to recruit 28 hemodialysis physicians from six TCM hospitals across five cities in Shandong Province, China. Data were collected through focus group and in-depth individual interviews with 28 hemodialysis physicians from November 2024 to January 2025, and were analyzed following Colaizzi’s descriptive analysis framework. The framework of the Society Ecosystems Theory was applied to analyze how multilevel systemic interactions shape ethical challenges, thereby constructing a multidimensional conceptual model.

Results

Ethical challenges encountered by hemodialysis physicians were categorized into three themes with seven subthemes and 17 subcategories. Based on these findings, a three-tiered model was developed: macro-system challenges involving policy, organizational, and cultural dimensions; meso-system challenges emerging from interprofessional dynamics, particularly doctor-doctor, doctor-nurse, and doctor-patient relationships; and micro-system challenges pertaining to individual difficulties.

Conclusion

The conceptual model reveals the multi-level nature of ethical challenges in hemodialysis practice, spanning systemic policies, interprofessional relationships, and individual dilemmas. The findings specifically call for targeted interventions at each level: policy reforms to address resource constraints, team-based strategies to improve clinical collaborations, and support systems to alleviate practitioners’ ethical distress. These evidence-based insights empower stakeholders to develop comprehensive solutions addressing the interconnected challenges identified.