Medical decision-making and information needs in end-stage renal disease patients

Orsino, Angela; Cameron, Jill I.; Seidl, Maja M.; Mendelssohn, David C.; Stewart, Donna E.

doi:10.1016/s0163-8343(03)00069-0

Cited by 58 publications

(88 citation statements)

References 18 publications

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“…It is therefore not surprising that some older people are more likely to prefer the healthcare team to make treatment decisions although there is wide variation in this [25]. There is also evidence that healthcare teams will respond by taking dialysis treatment decisions on behalf of older patients [26]. There is therefore a real risk within this patient group that the modality favoured by the renal team becomes the treatment of choice.…”

Section: Modality Education and Choicementioning

confidence: 99%

Optimising Treatment of End-Stage Renal Disease in the Elderly

Power¹,

Brown²

2014

Nephron Clin Pract

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The features of ageing complicate the management of end-stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with interventional treatments and quality of life. The presence of other illnesses and comorbidity associated with kidney disease mean that many patients have a poor prognosis. It is therefore important to consider the impact of dialysis on lifestyle and whether survival will actually be improved for frail older patients. This review article considers how haemodialysis and peritoneal dialysis can be adjusted for older patients, and, in particular, how the use of assistance makes peritoneal dialysis more feasible. Most importantly, older patients should be given realistic information about their prognosis and how they can cope with different treatment options, and then they should be involved in the decisions about their management.

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Section: Modality Education and Choicementioning

confidence: 99%

Optimising Treatment of End-Stage Renal Disease in the Elderly

Power¹,

Brown²

2014

Nephron Clin Pract

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“…Education is therefore critical in clarifying misconceptions. Older people are more likely to prefer the healthcare team to make treatment decisions, although there is wide variation in this [35,][36]. There is also evidence that healthcare teams will respond by taking dialysis treatment decisions on behalf of older patients [36].…”

Section: Modality Education and Older Peoplementioning

confidence: 99%

Dialysis Options for End-Stage Renal Disease in Older People

Brown

Johansson

2011

Nephron Clin Pract

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The numbers of older patients requiring dialysis therapy is rising, reflecting the ageing of the general population. Older dialysis patients have a tendency to present later for dialysis, have a higher number of comorbid conditions, are at higher risk of cognitive dysfunction and have increased levels of frailty. These are all barriers to home dialysis therapy so hospital haemodialysis (HD) is the predominant dialysis modality for older patients. Evidence suggests, however, that home treatment with peritoneal dialysis (PD) intrudes less into the life of older patients than hospital HD. Assisted PD is available in some countries and this enables more older patients to be treated in their own homes. Adjustments to patient education also need to be made to accommodate the barriers to learning and decision-making that often exist in older people.

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“…Patients with kidney disease report being open to engaging in ACP but expect health care providers to initiate these conversations (13)(14)(15)(16)(17). Barriers to ACP among renal providers include inadequate knowledge and training in communication, belief that ACP may be distressing for patients, concerns that ACP is too time consuming, difficulty estimating prognosis, and uncertainty about their role in ACP (18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

O’Hare

Szarka

McFarland

et al. 2016

CJASN

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Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.Results The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. ConclusionsThe comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.

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Medical decision-making and information needs in end-stage renal disease patients

Cited by 58 publications

References 18 publications

Optimising Treatment of End-Stage Renal Disease in the Elderly

Optimising Treatment of End-Stage Renal Disease in the Elderly

Dialysis Options for End-Stage Renal Disease in Older People

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

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