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A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease

BACKGROUND: Patients with end-stage renal disease (ESRD) frequently have a relatively poor prognosis with complex care needs that depend on prognosis. While many means of assessing prognosis are available, little is known about how Canadian nephrologists predict prognosis, whether they routinely sha...

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Autores principales: Forzley, Brian, Chiu, Helen H. L., Djurdjev, Ognjenka, Carson, Rachel C., Hargrove, Gaylene, Martinusen, Dan, Karim, Mohamud
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564856/
https://www.ncbi.nlm.nih.gov/pubmed/28835851
http://dx.doi.org/10.1177/2054358117725294
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author Forzley, Brian
Chiu, Helen H. L.
Djurdjev, Ognjenka
Carson, Rachel C.
Hargrove, Gaylene
Martinusen, Dan
Karim, Mohamud
author_facet Forzley, Brian
Chiu, Helen H. L.
Djurdjev, Ognjenka
Carson, Rachel C.
Hargrove, Gaylene
Martinusen, Dan
Karim, Mohamud
author_sort Forzley, Brian
collection PubMed
description BACKGROUND: Patients with end-stage renal disease (ESRD) frequently have a relatively poor prognosis with complex care needs that depend on prognosis. While many means of assessing prognosis are available, little is known about how Canadian nephrologists predict prognosis, whether they routinely share prognostic information with their patients, and how this information guides management. OBJECTIVE: To guide improvements in the management of patients with ESRD, we aimed to better understand how Canadian nephrologists consider prognosis during routine care. DESIGN AND METHODS: A web-based multiple choice survey was designed, and administered to adult nephrologists in Canada through the e-mail list of the Canadian Society of Nephrology. The survey asked the respondents about their routine practice of estimating survival and the perceived importance of prognostic practices and tools in patients with ESRD. Descriptive statistics were used in analyzing the responses. RESULTS: Less than half of the respondents indicated they always or often make an explicit attempt to estimate and/or discuss survival with ESRD patients not on dialysis, and 25% reported they do so always or often with patients on dialysis. Survival estimation is most frequently based on clinical gestalt. Respondents endorse a wide range of issues that may be influenced by prognosis, including advance care planning, transplant referral, choice of dialysis access, medication management, and consideration of conservative care. LIMITATIONS: This is a Canadian sample of self-reported behavior, which was not validated, and may be less generalizable to non-Canadian health care jurisdictions. CONCLUSIONS: In conclusion, prognostication of patients with ESRD is an important issue for nephrologists and impacts management in fairly sophisticated ways. Information sharing on prognosis may be suboptimal.
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spelling pubmed-55648562017-08-23 A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease Forzley, Brian Chiu, Helen H. L. Djurdjev, Ognjenka Carson, Rachel C. Hargrove, Gaylene Martinusen, Dan Karim, Mohamud Can J Kidney Health Dis Original Research Article BACKGROUND: Patients with end-stage renal disease (ESRD) frequently have a relatively poor prognosis with complex care needs that depend on prognosis. While many means of assessing prognosis are available, little is known about how Canadian nephrologists predict prognosis, whether they routinely share prognostic information with their patients, and how this information guides management. OBJECTIVE: To guide improvements in the management of patients with ESRD, we aimed to better understand how Canadian nephrologists consider prognosis during routine care. DESIGN AND METHODS: A web-based multiple choice survey was designed, and administered to adult nephrologists in Canada through the e-mail list of the Canadian Society of Nephrology. The survey asked the respondents about their routine practice of estimating survival and the perceived importance of prognostic practices and tools in patients with ESRD. Descriptive statistics were used in analyzing the responses. RESULTS: Less than half of the respondents indicated they always or often make an explicit attempt to estimate and/or discuss survival with ESRD patients not on dialysis, and 25% reported they do so always or often with patients on dialysis. Survival estimation is most frequently based on clinical gestalt. Respondents endorse a wide range of issues that may be influenced by prognosis, including advance care planning, transplant referral, choice of dialysis access, medication management, and consideration of conservative care. LIMITATIONS: This is a Canadian sample of self-reported behavior, which was not validated, and may be less generalizable to non-Canadian health care jurisdictions. CONCLUSIONS: In conclusion, prognostication of patients with ESRD is an important issue for nephrologists and impacts management in fairly sophisticated ways. Information sharing on prognosis may be suboptimal. SAGE Publications 2017-08-18 /pmc/articles/PMC5564856/ /pubmed/28835851 http://dx.doi.org/10.1177/2054358117725294 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page(https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research Article
Forzley, Brian
Chiu, Helen H. L.
Djurdjev, Ognjenka
Carson, Rachel C.
Hargrove, Gaylene
Martinusen, Dan
Karim, Mohamud
A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
title A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
title_full A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
title_fullStr A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
title_full_unstemmed A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
title_short A Survey of Canadian Nephrologists Assessing Prognostication in End-Stage Renal Disease
title_sort survey of canadian nephrologists assessing prognostication in end-stage renal disease
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564856/
https://www.ncbi.nlm.nih.gov/pubmed/28835851
http://dx.doi.org/10.1177/2054358117725294
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