Abstract: SA-PO673
Nephrologist/Patient Conversations About Renal Replacement
Session Information
- Home and Frequent Dialysis
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 604 Home and Frequent Dialysis
Authors
- Wise, Meg, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Schatell, Dorian R., Medical Education Institute, Madison, Wisconsin, United States
- Chewning, Betty, University of Wisconsin, Madison, Wisconsin, United States
- Chan, Micah R., University of Wisconsin-Madison, Madison, Wisconsin, United States
Background
Patient-centered, valued-based decision-making is the gold standard for choosing complex medical treatments.
Methods
We conducted a mixed-method conversation study to understand how nephrologists and patients communicate about renal replacement therapy (RRT), with 8 nephrologists from 3 clinics and 61 of their patients with eGFR <25. Analysis of verbatim transcripts of audio-recorded clinic visits assessed word ratios and discussion of RRT options. Surveys collected demographics and RRT preferences.
Results
Nephrologists established rapport with patients and worked to delay dialysis. RRT was the most uncomfortable part of the conversation for both nephrologists and patients: clinicians spoke ~3.25 times more in the whole visit, but ~8 times more about RRT, suggesting that patients shut down. In-center hemodialysis (HD), peritoneal dialysis (PD), and transplant (despite non-eligibility) were most often discussed; home HD was hardly discussed. Nephrologists’ used scripted didactic (teaching) versus dialogic (two-way) communication about RRT, perhaps overwhelming patients. Nephrologists may have inadvertently discouraged PD by emphasizing a need for a care partner (vs. optional), a sterile home (vs. just the dialysis room), and extensive training (vs. easy to learn). Home vs. center-borne infections, or that the “professionals” administering HD are largely technicians were not cited. Nephrologists did not talk about end-of-life or address patients’ emotional or existential concerns. They did not directly elicit patients’ values or tailor information-giving to those values even when patients inserted them. All but one nephrologist said they would use tools to help communicate more easily with their patients about RRT options.
Conclusion
A patient-centered values-based dialysis decision aid might serve as an ice-breaker, include the patients’ values into the RRT conversation, and increase patients’ participation in the RRT conversation and preferences for home dialysis.
Participant Demographics
| NEPHROLOGISTS | n=8 |
| Age, mean (range) | 39.43 (37-44) |
| Years of practice, mean (range) | 7 (2-10) |
| PATIENTS | n=61 |
| eGFR, mean (SD) | 20.62 (4.08) |
| Age, mean (SD), range | 68.82 (12.78) 25-94 |
| Female | 36 (60%) |
| < College degree | 40 (65%) |
Funding
- Commercial Support – Amgen, Inc.