Conservative care of the patient with end-stage renal disease

Alston, Helen; Burns, Áine

doi:10.7861/clinmedicine.15-6-567

Cited by 12 publications

(8 citation statements)

References 55 publications

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“…In this context, the number of patients who require kidney replacement therapy upon progressing to kidney failure is high. The choice of haemodialysis, despite its proven effectiveness, has caused great controversy in the last decade due to poor results in patients over 75 years of age (Andreu et al, 2015 ; Kane et al, 2013 ; Murtagh et al, 2016 ) or with numerous comorbidities and/or frailty (Alston & Burns, 2015 ; Davison et al, 2015 ). Although conservative treatment may not be the best option for these patients in terms of survival, it seems advantageous in terms of quality of life (Andreu et al, 2015 ; Eckert et al, 2018 ; Engelbrecht et al, 2021 ; Gelfand et al, 2020 ; Gutiérrez & Correa‐Rotter, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review

Ania-González

Martín-Martín

Amezqueta-Goñi

et al. 2022

Journal of Renal Care

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Background: Integrating the family of patients with kidney failure on comprehensive conservative care could benefit patients, families, and the health care system. However, there is a knowledge gap in this phenomenon since no systematic review has focused on the families' needs who care for individuals with kidney failure on comprehensive conservative care.Objectives: To understand the primary needs of families who care for people with kidney failure on comprehensive conservative care.Method: A systematic literature review of qualitative studies, followed by a content analysis was carried out. PubMed, CINAHL, and PsycINFO databases were used to search for articles published in English and Spanish between 2010 and 2021. The ENTREQ guideline was used for reporting.Results: Five relevant studies were included in this study. The analysis has allowed identifying key aspects of knowledge, psychological, social and spiritual needs of family members of patients with kidney failure on comprehensive conservative care.Conclusions: This systematic review has revealed that families experience a lack of information and continuity of care by health care professionals. Added to this is the psychological burden they bear due to the feeling of indefinite care in time and uncertainty about the death of their loved one. All this, without the necessary support from their immediate family environment and social institutions. In light of these data, a paradigm shift in society and the health care received by these families is essential.

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Section: Introductionmentioning

confidence: 99%

The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review

Ania-González

Martín-Martín

Amezqueta-Goñi

et al. 2022

Journal of Renal Care

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“…ESRD as irreversible decline of kidney function requires renal replacement therapy (dialysis or kidney transplantation) or conservative care (symptom management, anaemia control, non‐dialytic correction of fluid and electrolyte imbalance and end‐of‐life care; Alston & Burns, 2015; Raina et al, 2020). The prevalence of ESRD is higher in older patients over 65 years of age (Chen, Knicely, et al,).…”

Section: Introductionmentioning

confidence: 99%

Developing a conceptual model of older patients’ decision‐making process in choosing dialysis or conservative care using meta‐ethnography

Kim

Son

2021

Journal of Advanced Nursing

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Aims:To systematically review and synthesize qualitative evidence related to decisionmaking for treatment modalities among older adults with end-stage renal disease. Design:A meta-synthesis of the qualitative research was conducted. Data sources: A comprehensive literature review using PubMed, CINAHL, PsycINFO, Embase, Web of Sciences and Cochrane was systematically conducted. Qualitative studies published in English from January 2010 to October 2020 were considered. Review methods: Qualitative studies were systematically identified and critically appraised. Data synthesis was performed independently by two reviewers. This review followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.Results: Seven qualitative studies, with publication years ranging from 2015 to 2019, were included in the analysis. Overall, the review comprised studies with a total of 133 participants aged between 61 and 93 years. Through meta-synthesis, three themes were identified: 'reflecting on treatment options', 'confronting difficult decisions' and 'maintaining hope in everyday life'. Conclusion:Our findings reflect that older adults have varying preferences for treatment options. These preferences are influenced by various factors such as considering

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“…Particular challenges are biased between the groups compared (where there are unmeasured factors that determine which treatment the patient receives, i.e. confounding by indication), and lead-time bias (where it is hard to identify when dialysis would have been started in patients on a conservative care pathway [ 12 ]).…”

Section: Defining Conservative Carementioning

confidence: 99%

The Prepare for Kidney Care Study: prepare for renal dialysis versus responsive management in advanced chronic kidney disease

Murphy

Burns

Murtagh

et al. 2020

Nephrology Dialysis Transplantation

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Shared decision making in advanced chronic kidney disease (CKD) requires unbiased information on survival and person-centred outcomes known to matter to patients: quality of life, symptom burden and support from family and healthcare professionals. To date, when deciding between dialysis and conservative care, patients have had to rely on evidence from small observational studies. Clinicians recognize that like is not being compared with like in these studies, and interpret the results differently. Furthermore, support differs considerably between renal units. What patients choose therefore depends on which renal unit they attend. To address this, a programme of work has been underway in the UK. After reports on survival and symptoms from a small number of renal units, a national, mixed-methods study—the Conservative Kidney Management Assessment of Practice Patterns Study—mapped out conservative care practices and attitudes in the UK. This led to the Prepare for Kidney Care study, a randomized controlled trial comparing preparation for dialysis versus preparation for conservative care. Although powered to detect a positivist 0.345 difference in quality-adjusted life years between the two treatments, this trial also takes a realist approach with a range of person-centred secondary outcomes and embedded qualitative research. To understand generalizability, it is nested in an observational cohort study, which is nested in a CKD registry. Challenges to recruitment and retention have been rapidly identified and addressed using an established embedded mixed methods approach—the QuinteT recruitment intervention. This review considers the background to and progress with recruitment to the trial.

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Conservative care of the patient with end-stage renal disease

Cited by 12 publications

References 55 publications

The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review

The needs of families who care for individuals with kidney failure on comprehensive conservative care: A qualitative systematic review

Developing a conceptual model of older patients’ decision‐making process in choosing dialysis or conservative care using meta‐ethnography

The Prepare for Kidney Care Study: prepare for renal dialysis versus responsive management in advanced chronic kidney disease

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