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Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia

INTRODUCTION: For elderly end-stage renal disease (ESRD) patients with multiple comorbidities, dialysis may offer little survival benefit compared to conservative management (CM). Yet, many elderly ESRD patients undergo dialysis, partly due to physicians’ recommendations regarding treatment choice....

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Autores principales: Finkelstein, Eric A., Ozdemir, Semra, Malhotra, Chetna, Jafar, Tazeen H., Choong, Hui Lin, Suhardjono, Johnny
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678627/
https://www.ncbi.nlm.nih.gov/pubmed/29142957
http://dx.doi.org/10.1016/j.ekir.2016.12.002
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author Finkelstein, Eric A.
Ozdemir, Semra
Malhotra, Chetna
Jafar, Tazeen H.
Choong, Hui Lin
Suhardjono, Johnny
author_facet Finkelstein, Eric A.
Ozdemir, Semra
Malhotra, Chetna
Jafar, Tazeen H.
Choong, Hui Lin
Suhardjono, Johnny
author_sort Finkelstein, Eric A.
collection PubMed
description INTRODUCTION: For elderly end-stage renal disease (ESRD) patients with multiple comorbidities, dialysis may offer little survival benefit compared to conservative management (CM). Yet, many elderly ESRD patients undergo dialysis, partly due to physicians’ recommendations regarding treatment choice. This study aims to elucidate the factors that influence these recommendations. METHODS: We surveyed a convenience sample of physicians who attended the 9th Asian Forum of Chronic Kidney Disease Initiative conference. We used vignettes that vary by age and comorbidity status, and asked physicians to recommend dialysis or CM for a hypothetical patient with that profile and to predict survival with both treatment options. We also compared the physician’s recommendations to patients for what they would recommend for themselves if they were diagnosed with ESRD. RESULTS: On average, physicians believed that dialysis extends life relative to CM. Yet, a large subset believed that CM confers greater survival. Estimates range from 17.3% (for a 65-year-old with diabetes and CHF) to 50% for patients with advanced cancer. Results further reveal high discordance regarding treatment recommendations. For a 65-year-old patient with diabetes, 62% recommended dialysis and 38% did not. For advanced cancer, the split was 25% and 75%. Physicians were far more likely to recommend dialysis for themselves than for their patients. DISCUSSION: This study suggests that physicians would benefit from a greater understanding of survival benefits of dialysis and CM for elderly patients with different comorbidity profiles. This would allow patients to make more informed decisions.
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spelling pubmed-56786272017-11-15 Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia Finkelstein, Eric A. Ozdemir, Semra Malhotra, Chetna Jafar, Tazeen H. Choong, Hui Lin Suhardjono, Johnny Kidney Int Rep Clinical Research INTRODUCTION: For elderly end-stage renal disease (ESRD) patients with multiple comorbidities, dialysis may offer little survival benefit compared to conservative management (CM). Yet, many elderly ESRD patients undergo dialysis, partly due to physicians’ recommendations regarding treatment choice. This study aims to elucidate the factors that influence these recommendations. METHODS: We surveyed a convenience sample of physicians who attended the 9th Asian Forum of Chronic Kidney Disease Initiative conference. We used vignettes that vary by age and comorbidity status, and asked physicians to recommend dialysis or CM for a hypothetical patient with that profile and to predict survival with both treatment options. We also compared the physician’s recommendations to patients for what they would recommend for themselves if they were diagnosed with ESRD. RESULTS: On average, physicians believed that dialysis extends life relative to CM. Yet, a large subset believed that CM confers greater survival. Estimates range from 17.3% (for a 65-year-old with diabetes and CHF) to 50% for patients with advanced cancer. Results further reveal high discordance regarding treatment recommendations. For a 65-year-old patient with diabetes, 62% recommended dialysis and 38% did not. For advanced cancer, the split was 25% and 75%. Physicians were far more likely to recommend dialysis for themselves than for their patients. DISCUSSION: This study suggests that physicians would benefit from a greater understanding of survival benefits of dialysis and CM for elderly patients with different comorbidity profiles. This would allow patients to make more informed decisions. Elsevier 2016-12-13 /pmc/articles/PMC5678627/ /pubmed/29142957 http://dx.doi.org/10.1016/j.ekir.2016.12.002 Text en © 2016 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Finkelstein, Eric A.
Ozdemir, Semra
Malhotra, Chetna
Jafar, Tazeen H.
Choong, Hui Lin
Suhardjono, Johnny
Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia
title Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia
title_full Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia
title_fullStr Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia
title_full_unstemmed Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia
title_short Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia
title_sort identifying factors that influence physicians’ recommendations for dialysis and conservative management in indonesia
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678627/
https://www.ncbi.nlm.nih.gov/pubmed/29142957
http://dx.doi.org/10.1016/j.ekir.2016.12.002
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