Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study.

Autor:	Beckwith HKS; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.; Department of Renal Medicine, Imperial College London, London, United Kingdom., Adwaney A; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Appelbe M; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Gaffney HT; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Hill P; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Moabi D; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Prout VL; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Salisbury E; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Webster P; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Tomlinson JAP; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom., Brown EA; Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom.; Department of Renal Medicine, Imperial College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Kidney international reports [Kidney Int Rep] 2021 Mar 03; Vol. 6 (6), pp. 1558-1566. Date of Electronic Publication: 2021 Mar 03 (Print Publication: 2021).
DOI:	10.1016/j.ekir.2021.02.032
Abstrakt:	Introduction: A better understanding of factors influencing perceived life expectancy (PLE), interactions between patient prognostic beliefs, experiences of illness, and treatment behavior is urgently needed. Methods: Case-notes at 3 hemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their health care professionals (HCPs) were invited to complete a structured interview or mixed-methods questionnaire. Four hundred eleven patient notes were screened. Seventy-seven eligible patients were approached and 51 were included. Results: Patients predicted significantly higher life expectancies than HCPs ( P  < 0.0001). Documented cognitive impairment, gender, or increasing age did not affect 1- or 5-year PLE. PLE influenced priorities of care: one-fifth of patients who estimated themselves to have >95% 1-year survival preferred "care focusing on relieving pain and discomfort," compared with nearly three-quarters of those reporting a ≤50% chance of 1-year survival. Twenty of 51 (39%) patients believed transplantation was an option for them, despite only 4 being waitlisted at the time of the interview. Patients who thought they were transplant candidates were significantly more confident they would be alive at 1 and 5 years and to want resuscitation attempted. Cognitive impairment had no effect on perceived transplant candidacy. A high symptom burden was present and underrecognized by HCPs. High symptom burden was associated with significantly lower PLE at both 1 and 5 years, increased anxiety/depression scores, and treatment choices more likely to prioritize relief of suffering. Conclusion: There is a disparity between patient PLE and those of their HCPs. Severity of symptom burden and beliefs regarding PLE or transplant candidacy affect patient treatment preferences. (© 2021 International Society of Nephrology. Published by Elsevier Inc.)
Databáze:	MEDLINE
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