Perceptions of Illness Severity, Treatment Goals, and Life Expectancy: The ePISTLE Study
| Autor: | Anamika Adwaney, Emma Salisbury, James Tomlinson, Hannah Beckwith, Edwina A. Brown, Dihlabelo Moabi, Helen T. Gaffney, Phil Webster, Maura Appelbe, Virginia L. Prout, Peter Hill |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
symptom burden shared decision making 030232 urology & nephrology 030204 cardiovascular system & hematology Affect (psychology) 03 medical and health sciences 0302 clinical medicine risk communication Clinical Research Health care medicine Depression (differential diagnoses) business.industry perceived life expectancy Diseases of the genitourinary system. Urology Transplantation Nephrology Family medicine Structured interview Candidacy Life expectancy Anxiety RC870-923 prognosis medicine.symptom business |
| Zdroj: | Kidney International Reports Kidney International Reports, Vol 6, Iss 6, Pp 1558-1566 (2021) |
| ISSN: | 2468-0249 |
| Popis: | 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. Graphical abstract |
| Databáze: | OpenAIRE |
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