Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care.

Autor:	Barrett TM; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC., Green JA; Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA.; Kidney Health Research Institute, Danville, PA., Greer RC; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD., Ephraim PL; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD., Peskoe S; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC., Pendergast JF; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC., Hauer CL; Center for Clinical Innovation, Institute for Advanced Application, Danville, PA., Strigo TS; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC., Norfolk E; Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA., Bucaloiu ID; Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA., Diamantidis CJ; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.; Division of Nephrology, Duke University School of Medicine, Durham, NC., Hill-Briggs F; Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD.; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD., Browne T; College of Social Work, University of South Carolina, Columbia, SC., Jackson GL; Center for Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC.; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC., Boulware LE; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC.
Jazyk:	angličtina
Zdroj:	Kidney medicine [Kidney Med] 2021 Jul 30; Vol. 3 (6), pp. 905-915.e1. Date of Electronic Publication: 2021 Jul 30 (Print Publication: 2021).
DOI:	10.1016/j.xkme.2021.05.011
Abstrakt:	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. (© 2021 Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.)
Databáze:	MEDLINE
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