Does the Evidence Support Conservative Management as an Alternative to Dialysis for Older Patients with Advanced Kidney Disease?

Tam-Tham, Helen; Thomas, Chandra

doi:10.2215/cjn.01910216

Cited by 14 publications

(10 citation statements)

References 16 publications

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“…Alternatively, this finding may reflect the widely held perception and hope among providers, patients, and families that dialysis treatment automatically confers a survival benefit for everyone, thus precluding the need for hospice. This perception is supported by a recent study that found that the majority of patients with advanced CKD received or were preparing to receive dialysis regardless of age or comorbidity (16), despite a growing body of observational studies from Europe showing that elderly patients with serious illness in addition to ESRD who receive conservative management without dialysis may live just as long as those who do have dialysis (6,(17)(18)(19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 98%

Characteristics and Outcomes of In-Hospital Palliative Care Consultation among Patients with Renal Disease Versus Other Serious Illnesses

Grubbs

Pantilat

2017

CJASN

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Section: Discussionmentioning

confidence: 98%

Characteristics and Outcomes of In-Hospital Palliative Care Consultation among Patients with Renal Disease Versus Other Serious Illnesses

Grubbs

Pantilat

2017

CJASN

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“…While initiating dialysis lengthens life for some older adults, the survival benefit appears small or non-existent in those with comorbidities or frailty [3]. The burden of dialysis and its effect on quality of life also outweigh the benefit of longevity for some patients [4, 5]; hence chosen or medically advised ‘comprehensive conservative kidney care’ [6] is recognised as an acceptable alternative [4, 7]. It comprises all aspects of renal care without preparing for dialysis, in conjunction with a multidisciplinary palliative care approach [6].…”

Section: Introductionmentioning

confidence: 99%

The views and experiences of older people with conservatively managed renal failure: a qualitative study of communication, information and decision-making

et al. 2019

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BackgroundOlder people with advanced kidney disease require information and support from clinicians when deciding whether to have dialysis or conservative (non-dialysis) care. There is evidence that communication practices, information provision and treatment rates vary widely across renal units. However, experiences of communicating with clinicians among patients receiving conservative care are poorly understood. This evidence is essential to ensure support is patient-centred and equitable. Our aim was to explore views and experiences of communication, information provision and treatment decision-making among older patients receiving conservative care.MethodsIn-depth qualitative interviews were conducted with patients with stage 5 chronic kidney disease from three UK renal units. Purposive sampling captured variation in age, co-morbidity and functional status. Interviews were analysed thematically.Results20 patients were interviewed (11 were men; median age 82 (range 69–95)). Participants described positive experiences of communicating with clinicians and receiving information, but also negative experiences involving insensitivity, rushing or ambiguity. Participants reported clinicians omitting/avoiding conversations regarding diagnosis and prognosis, and described what helped and hindered good communication and support. They wanted information about their treatment options and illness, but expressed ambivalence about knowing details of disease progression. Clinicians’ views and recommendations regarding treatment influenced patients’ decision-making.ConclusionsOlder patients report variable quality in communication with clinicians and gaps in the information received. Uncertainty about the disease trajectory and patients’ ambivalence regarding information makes communication particularly challenging for clinicians. Tailoring information to patient preferences and conveying it clearly and sensitively is critical. Renal clinicians require support and training to ensure decision-making support for older patients is patient-centred. Future research should examine how clinicians’ communication practices influence treatment decision-making.

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“…Older adults begin dialysis more frequently than any other group in the United States, yet some regret initiating dialysis (1)(2)(3). For many patients with CKD over age 75 years old, dialysis may not confer a significant survival benefit over conservative management while increasing utilization of intensive endof-life care and potentially adversely affecting quality of life (4)(5)(6)(7). Most patients are more satisfied when engaged in decision making, and clinical guidelines encourage shared decision making with older patients (2,3,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Characterizing Approaches to Dialysis Decision Making with Older Adults

Ladin

Pandya

Perrone

et al. 2018

CJASN

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Does the Evidence Support Conservative Management as an Alternative to Dialysis for Older Patients with Advanced Kidney Disease?

Cited by 14 publications

References 16 publications

Characteristics and Outcomes of In-Hospital Palliative Care Consultation among Patients with Renal Disease Versus Other Serious Illnesses

Characteristics and Outcomes of In-Hospital Palliative Care Consultation among Patients with Renal Disease Versus Other Serious Illnesses

The views and experiences of older people with conservatively managed renal failure: a qualitative study of communication, information and decision-making

Characterizing Approaches to Dialysis Decision Making with Older Adults

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