Predicting 3-Year Survival in Patients Receiving Maintenance Dialysis: An External Validation of iChoose Kidney in Ontario, Canada

Tan, Vivian; Garg, Amit X.; McArthur, Eric; Patzer, Rachel E.; Gander, Jennifer C.; Roshanov, Pavel S; Kim, S Joseph; Knoll, Greg; Yohanna, Seychelle; McCallum, Megan K.; Naylor, Kyla L.

doi:10.1177/2054358118799693

Cited by 6 publications

(4 citation statements)

References 33 publications

(39 reference statements)

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“…A key barrier to ACD discussion is the limited ability for caregivers to accurately estimate prognosis. 13,14,24 We specifically examined characteristics associated with DNR status to identify emerging risk factors that may trigger ACD discussions. We identified 2 functional measures (inability or requiring aid for meal preparation, laundry) that were more common with a DNR order.…”

Section: Discussionmentioning

confidence: 99%

“…Barriers to improve ACD planning include the lack of time required for a full discussion, concerns about invoking hopelessness in patients, lack of training for staff in ACD discussions, limited information on prognostication, and uncertainty when ACD discussions should occur. 11-14 To better improve EOL care for patients, we examined the interprovincial and within Ontario variation in DNR orders and identified clinical characteristics (demographic, comorbidities, and functionality) associated with a DNR order.…”

Section: Introductionmentioning

confidence: 99%

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Facility Variation and Predictors of Do Not Resuscitate Orders of Hemodialysis Patients in Canada: DOPPS

Moorman

Mallick

Rhodes

et al. 2019

Can J Kidney Health Dis

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Background: Life expectancy in patients with end-stage kidney disease treated with hemodialysis (HD) is limited, and as such, the presence of an advanced care directive (ACD) may improve the quality of death as experienced for patients and families. Strategies to discuss and implement ACDs are limited with little being known about the status of Do Not Resuscitate (DNR) orders in the Canadian HD population. Objectives: Using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), we set out to (1) examine the variability in DNR orders across Canada and its largest province, Ontario and (2) identify clinical and functional status measures associated with a DNR order. Design: We conducted a retrospective cohort study using data from the DOPPS Canada Phase 4 to 6 from 2009 to 2017. Setting: DOPPS facilities in Canada. Patients: All adults (>18 years) who initiated chronic HD with a documented ACD were included. Measurements: ACD and DNR orders. Methods: Descriptive statistics were compared for baseline characteristics (demographics, comorbidities, medications, facility characteristics, and patient functional status) and DNR status. The crude proportion of patients per facility with a DNR order was calculated across Canada and Ontario. Functional status was determined by activities of daily living and components of the Kidney Disease Quality of Life (KDQOL)-validated questionnaire. We used generalized estimating equations (GEEs) to create sequential multivariable models (demographics, comorbidities, and functional status) of variables associated with DNR status. Results: A total of 1556 (96% of total) patients treated with HD had a documented ACD and were included. A total of 10% of patients had a DNR order. The crude variation of DNR status differed considerably across facilities within Canada, between Ontario and non-Ontario, and within Ontario (interprovince variation = 6.3%-17.1%, Ontario vs non-Ontario = 8.2% vs 11.7%, intraprovincial variation [Ontario] = 1%-26%). Patients with a DNR order were more commonly older, white, with cardiac comorbidities, with less or shorter predialysis care compared with those without a DNR order. Patients with a DNR order reported lower energy, more difficulty with transfers, meal preparation, household tasks, and financial management. In a multivariate model, age, cardiac disease, stroke, dialysis duration, and intradialytic weight gain were associated with DNR status. Limitations: Relatively small number of events or measures in certain categories. Conclusions: A large inter- and intraprovincial (Ontario) variation was observed regarding DNR orders across Canada highlighting areas for potential quality improvement. While functional status did not appear to have a bearing on the presence of a DNR order, the presence of various comorbidities was associated with the presence of a DNR order.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Facility Variation and Predictors of Do Not Resuscitate Orders of Hemodialysis Patients in Canada: DOPPS

Moorman

Mallick

Rhodes

et al. 2019

Can J Kidney Health Dis

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“…63 In a 2018 external validation of the app, including 22 520 patients on maintenance dialysis and 4505 kidney transplant recipients in Ontario, Canada, the adapted iChooseKidney tool had adequate predictive accuracy. 143 The app is being used in a multifaceted provincial quality initiative to improve access to KT and LDKT in Ontario. 144 A study tested a Web-based LT decision aid and found that it was feasible and improved knowledge among LT candidates.…”

Section: Electronic and Mobile Health Initiativesmentioning

confidence: 99%

Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review

et al. 2021

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Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.

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“…Development of the resources and papers should include a critical literature review of published data on prognostic tools for survival of dialysis and conservative pathway patients. Useful resources include papers by Couchoud et al, 31 McArthur et al, 32 and Tan et al 33 Explanatory notes for Table 22, Conservative Kidney Management Project C4. A set of materials will be identified, collated, and assembled, including those identified in Project C3.…”

Section: Deliverablesmentioning

confidence: 99%