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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....
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2016
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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. |
format | Online Article Text |
id | pubmed-5678627 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
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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