Patient and physician perspectives on shared decision-making for coronary procedures in people with chronic kidney disease: a patient-oriented qualitative study.

Autor: Finlay J; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Wilson T; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Javaheri PA; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Pearson W; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Connolly C; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Elliott MJ; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Graham MM; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Norris CM; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., Wilton SB; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta., James MT; Departments of Medicine (Finlay, Javaheri, Pearson, Elliott, James), Community Health Sciences (Wilson, Wilton, James) and Cardiac Sciences (Connolly, Wilton), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Medicine (Graham), Faculty of Medicine & Dentistry, and Faculty of Nursing (Norris), University of Alberta, Edmonton, Alta. mjames@ucalgary.ca.
Jazyk: angličtina
Zdroj: CMAJ open [CMAJ Open] 2020 Dec 10; Vol. 8 (4), pp. E860-E868. Date of Electronic Publication: 2020 Dec 10 (Print Publication: 2020).
DOI: 10.9778/cmajo.20200039
Abstrakt: Background: Patients with chronic kidney disease (CKD) and heart disease face challenging treatment decisions. We sought to explore the perceptions of patients and physicians about shared decision-making for coronary procedures for people with CKD, as well as opinions about strategies and tools to improve these decisions.
Methods: We partnered with 4 patients with CKD and 1 caregiver to design and conduct a qualitative descriptive study using semi-structured interviews and content analysis. Patient participants with CKD and either acute coronary syndrome or cardiac catheterization in the preceding year were recruited from a provincial cardiac registry, cardiology wards and clinics in Calgary between March and September 2018. Cardiologists from the region also participated in the study. Data analysis emphasized identifying, organizing and describing themes found within the data.
Results: Twenty patients with CKD and 10 cardiologists identified several complexities related to bidirectional information exchange needed for shared decision-making. Themes identified by both patients and physicians included challenges synthesizing best evidence, variable patient knowledge seeking, timeliness in the acute care setting and influence of roles on decision-making. Themes identified by physicians related to processes and tools to help support shared decision-making in this setting included personalization to reflect the variability of risks and heterogeneity of patient preferences as well as allowing for physicians to share their clinical judgment.
Interpretation: There are complexities related to bidirectional information exchange between patients with CKD and their physicians for shared decision-making about coronary procedures. Processes and tools to facilitate shared decision-making in this setting require personalization and need to be time sensitive.
Competing Interests: Competing interests: Matthew James has received investigator-initiated research grant funding for unrelated work from Amgen Canada. No other competing interests were declared.
(Copyright 2020, Joule Inc. or its licensors.)
Databáze: MEDLINE
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