Kidney Week

Abstract: SA-PO443

Why Select Conservative Management? A Qualitative Study of Patient-Identified Factors and Influences Contributing to Advanced Kidney Disease Patients’ Decisions to Choose Non-Dialysis Care

Session Information

• CKD: Epidemiology, Outcomes - Non-Cardiovascular - II
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 306 CKD: Cognitive Dysfunction, Depression, Quality of Life

Authors

• Lu, Emily, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States

Emily Lu,

• Silberzweig, Jeffrey I., The Rogosin Institute, New York, New York, United States

Jeffrey I. Silberzweig,

• Hennon, Anna Marian, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States

Anna Marian Hennon,

• Berman, Nathaniel E., The Rogosin Institute, New York, New York, United States

Nathaniel E. Berman,

• Adelman, Ronald D., Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States

Ronald D. Adelman,

• Shen, Megan Johnson, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States

Megan Johnson Shen,

• Lampa, Katherine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States

Katherine Lampa,

• Reid, Manney Carrington, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, United States

Manney Carrington Reid,

Background

Conservative management (CM) of advanced chronic kidney disease (CKD) continues to be an area of growing interest. However, in the United States, little is known about why and how patients decide to pursue CM. The purpose of this study is to better understand why American patients with advanced CKD select CM and to identify factors or influences important to them in this decision-making process.

Methods

Patients with estimated glomerular filtration rate (eGFR) <30 ml/min who had previously made the decision to select CM—non-dialysis care—for their CKD were recruited. Semi-structured interviews of 15 patients were conducted, audiotaped, and transcribed. Data were analyzed inductively using grounded theory to identify common themes in patients' narratives.

Results

Four emerging themes were identified: 1) Choice of CM remains ultimately fluid, provisional, or circumstance-dependent (patients would consider dialysis if specific situation(s) developed, e.g. imminent danger/death, nephrologist recommendation, no longer felt well); 2) Importance of quality of life (negative impact of time required for dialysis, wish to live without restriction/limitation); 3) Currently feeling well (selected CM because does not feel sick); 4) Gaps in knowledge of and/or discussion with nephrologist regarding CKD care options (lack of recollection of discussion or content, difficulty describing anticipated symptoms of CKD progression).

Conclusion

Understanding how advanced CKD patients select CM as a treatment option for their CKD provides insight regarding the values/beliefs, motivations, and concerns they take into account during the decision-making process. Further interviews will be conducted to reach thematic saturation. The identified themes will inform a future longitudinal study of treatment decision-making in advanced CKD.