Determinants of regret in elderly dialysis patients

Tan, Edlyn G F; Teo, Irene; Finkelstein, Eric A.; Meng, Chan

doi:10.1111/nep.13400

Cited by 22 publications

(26 citation statements)

References 36 publications

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“…The incurability of kidney failure forces patients to reinvent themselves, make compromises or adopt beliefs or behaviours discordant with medical opinion 47–50. Despite these burdens, the majority of patients reported satisfaction with treatment and improvement of symptoms; another study found that the majority of patients reported no decision regret or ambivalence about starting dialysis 51 52. It should be noted, however, that patients’ decisions, goals and expectations are not static but change with time as different issues emerge 42 53…”

Section: Resultsmentioning

confidence: 99%

Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

et al. 2019

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ObjectivesThis review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.DesignWe followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.Data sourcesPubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).Eligibility criteria for inclusionArticles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.Data extraction and synthesisTwo independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.Results248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.ConclusionWhen discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.

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Section: Resultsmentioning

confidence: 99%

Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

et al. 2019

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“…As ESRD patients and their caregivers navigate these choices, there is a need for supportive, contextually appropriate decision‐making aids to enable informed decision making. Evidence from Singapore has shown that lack of knowledge of CM and deference to physician recommendations may lead older ESRD patients to seek dialysis and that a small proportion of patients later regret their decision to start dialysis . Work done elsewhere has also shown that most older patients have unrealistic expectations of dialysis upon commencing treatment, and has suggested the need for age‐specific information tailored to older ESRD patients that clearly communicate the risks, benefits and burdens associated with dialysis …”

Section: Introductionmentioning

confidence: 99%

“…Evidence from Singapore has shown that lack of knowledge of CM and deference to physician recommendations may lead older ESRD patients to seek dialysis 10 and that a small proportion of patients later regret their decision to start dialysis. 11 Work done elsewhere has also shown that most older patients have unrealistic expectations of dialysis upon commencing treatment, 12 and has suggested the need for age-specific information tailored to older ESRD patients that clearly communicate the risks, benefits and burdens associated with dialysis. 13 Presently, there is limited research exploring the treatment decision-making process of older ESRD patients and caregivers, and the majority of current literature is centred on Western populations.…”

Section: Introductionmentioning

confidence: 99%

Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study

Han

Haldane

Koh

et al. 2019

Health Expectations

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BackgroundEnd‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits.ObjectiveThis study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis.DesignQualitative study design using semi‐structured interviews.Setting and participantsTwenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers.ResultsWhile some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden.Discussion and conclusionThis study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.

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“…Even in people who commence dialysis, decision regret could be measured over the first 3–6 months to detect whether changes occur over time once the realization of the actual burden of dialysis on every day develops. In a recent study, decision regret was associated with older age and significantly associated with longer duration on dialysis (Tan, Teo, Finkelstein, & Chan, ). Additionally, in this same study, those people who had lower satisfaction with the information provided were more likely to experience decision regret (Tan et al, ).…”

Section: Discussionmentioning

confidence: 98%

“…In a recent study, decision regret was associated with older age and significantly associated with longer duration on dialysis (Tan, Teo, Finkelstein, & Chan, ). Additionally, in this same study, those people who had lower satisfaction with the information provided were more likely to experience decision regret (Tan et al, ). Both our study and Tan et al suggest that the use of a DSI such as OPTIONS could have a role in lowering decision regret.…”

Section: Discussionmentioning

confidence: 98%

A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease

Brown

Gardner

Bonner

2019

Journal of Advanced Nursing

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Aim To evaluate the effectiveness of a decision support intervention (OPTIONS) in facilitating the older person with advanced kidney disease to make a treatment choice. Design Pragmatic randomized controlled trial. Methods People aged ≥70 years with advanced kidney disease (eGFR ≤20 ml/min/1.73m2) who had not made a decision about treatment options and who were not eligible for a kidney transplant were recruited between March 2015 and March 2016. Participants were randomly allocated to receive the OPTIONS (N = 16) or standard care (N = 21). OPTIONS is a 4‐week nurse‐delivered intervention. Primary outcomes were decision conflict and decision regret, the secondary outcomes were knowledge of risk and benefits of dialysis and health‐related quality of life. The usefulness of OPTIONS was also evaluated. Results There were no differences between the intervention and standard care groups at baseline. At T1, there were no significant differences in decision conflict and decision regret although the intervention group had lower decisional conflict at T2. The decision support intervention was able to significantly improve the participants’ knowledge score in the intervention group. There were no observable differences between groups for health‐related quality of life physical and mental health component summary scores. OPTIONS was helpful in preparing participants in making a treatment decision. Conclusion OPTIONS, a decision support intervention, increased a person's knowledge of the benefits and risks of dialysis and can be used to facilitate shared decision‐making with older adults with advanced stages of kidney disease. Impact Strategies to improve shared decision‐making between older people with advanced stages of kidney disease and their clinicians are crucial for patient autonomy in a population where this may not be common practice. The decision support intervention– OPTIONS demonstrated significant improvement in patient knowledge about different treatment pathways. OPTIONS provides a structured and evidence‐based approach to support shared decision‐making for this population. Trial Registration ACTRN 12614001090606 Registered 14/10/2014.

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Determinants of regret in elderly dialysis patients

Cited by 22 publications

References 36 publications

Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study

A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease

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