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Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care
RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients’ preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacemen...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664702/ https://www.ncbi.nlm.nih.gov/pubmed/34939000 http://dx.doi.org/10.1016/j.xkme.2021.05.011 |
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author | Barrett, Tyler M. Green, Jamie A. Greer, Raquel C. Ephraim, Patti L. Peskoe, Sarah Pendergast, Jane F. Hauer, Chelsie L. Strigo, Tara S. Norfolk, Evan Bucaloiu, Ion Dan Diamantidis, Clarissa J. Hill-Briggs, Felicia Browne, Teri Jackson, George L. Boulware, L. Ebony |
author_facet | Barrett, Tyler M. Green, Jamie A. Greer, Raquel C. Ephraim, Patti L. Peskoe, Sarah Pendergast, Jane F. Hauer, Chelsie L. Strigo, Tara S. Norfolk, Evan Bucaloiu, Ion Dan Diamantidis, Clarissa J. Hill-Briggs, Felicia Browne, Teri Jackson, George L. Boulware, L. Ebony |
author_sort | Barrett, Tyler M. |
collection | PubMed |
description | RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients’ preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: Adults receiving nephrology care at CKD clinics in rural Pennsylvania. PREDICTORS: Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. OUTCOMES: Occurrence and extent of kidney replacement therapy discussions and participants’ satisfaction with those discussions. ANALYTIC APPROACH: Multivariable logistic regression to quantify associations between participants’ characteristics and whether they had discussions. RESULTS: The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m(2). Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. LIMITATIONS: Single health system study. CONCLUSIONS: Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences. |
format | Online Article Text |
id | pubmed-8664702 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-86647022021-12-21 Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care Barrett, Tyler M. Green, Jamie A. Greer, Raquel C. Ephraim, Patti L. Peskoe, Sarah Pendergast, Jane F. Hauer, Chelsie L. Strigo, Tara S. Norfolk, Evan Bucaloiu, Ion Dan Diamantidis, Clarissa J. Hill-Briggs, Felicia Browne, Teri Jackson, George L. Boulware, L. Ebony Kidney Med Original Research RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients’ preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. STUDY DESIGN: Cross-sectional study. SETTING & PARTICIPANTS: Adults receiving nephrology care at CKD clinics in rural Pennsylvania. PREDICTORS: Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. OUTCOMES: Occurrence and extent of kidney replacement therapy discussions and participants’ satisfaction with those discussions. ANALYTIC APPROACH: Multivariable logistic regression to quantify associations between participants’ characteristics and whether they had discussions. RESULTS: The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m(2). Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. LIMITATIONS: Single health system study. CONCLUSIONS: Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences. Elsevier 2021-07-30 /pmc/articles/PMC8664702/ /pubmed/34939000 http://dx.doi.org/10.1016/j.xkme.2021.05.011 Text en © 2021 Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. https://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 | Original Research Barrett, Tyler M. Green, Jamie A. Greer, Raquel C. Ephraim, Patti L. Peskoe, Sarah Pendergast, Jane F. Hauer, Chelsie L. Strigo, Tara S. Norfolk, Evan Bucaloiu, Ion Dan Diamantidis, Clarissa J. Hill-Briggs, Felicia Browne, Teri Jackson, George L. Boulware, L. Ebony Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care |
title | Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care |
title_full | Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care |
title_fullStr | Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care |
title_full_unstemmed | Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care |
title_short | Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care |
title_sort | preferences for and experiences of shared and informed decision making among patients choosing kidney replacement therapies in nephrology care |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8664702/ https://www.ncbi.nlm.nih.gov/pubmed/34939000 http://dx.doi.org/10.1016/j.xkme.2021.05.011 |
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