Patient-nephrologist prognostic awareness and discordance in end stage renal disease on renal replacement therapy
| Autor: | Evgenia Granina, Frank Forte, Sassine Ghanem, Samer Saouma, Nicholas Fuca, Sami Hossri |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Nephrology Health Knowledge Attitudes Practice medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Comorbidity 030204 cardiovascular system & hematology urologic and male genital diseases End stage renal disease Nephrologists Young Adult 03 medical and health sciences Life Expectancy 0302 clinical medicine Quality of life Surveys and Questionnaires Internal medicine medicine Humans Renal replacement therapy Intensive care medicine Aged Aged 80 and over Terminal Care Past medical history business.industry Communication Mortality rate Age Factors Middle Aged Prognosis female genital diseases and pregnancy complications Renal Replacement Therapy Kidney Failure Chronic Female Hemodialysis business End-of-life care |
| Zdroj: | International Urology and Nephrology. 52:765-773 |
| ISSN: | 1573-2584 0301-1623 |
| Popis: | The 1-year mortality rate of patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT) is 20–25% comparable to many cancers. Studies have shown that cancer patients commonly overestimate their likelihood of survival relative to their physicians. It is unclear if this translates into other terminal illnesses. Adult and elderly patients with ESRD on RRT without cognitive defect were interviewed to evaluate their prognostic estimates at 1 and 5 years. Past medical history and demographic data was abstracted from their medical charts. Each patient’s proper nephrologist was then interviewed regarding his proper prognostic estimate for this patient. Both the patient and the nephrologist’s estimates were compared and a difference of greater than 20% was defined as the threshold for prognostic concordance. 77% of patients were found to be in prognostic discordance with their nephrologists. This group was older, had more comorbidities, a lower albumin level and a poorer prognosis. The majority of patients were in disagreement with their nephrologists regarding whether a discussion about prognosis had taken place. The choice of end of life care for 55% of patients was focused on relieving pain and discomfort. Communication of prognosis and discussions related to life expectancy and end of life care are lacking in the routine care of ESRD patients. ESRD patients therefore tend to overestimate their prognosis which might lead to overutilization of invasive procedures with increased acute healthcare costs as well as a delay in instigation of palliative or hospice measures. |
| Databáze: | OpenAIRE |
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