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Kidney Week

Abstract: SA-PO740

Prognosis in Shared Decision Making for Advanced CKD: A Qualitative Study

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Thorsteinsdottir, Bjoerg, Mayo Clinic, Rochester, Minnesota, United States
  • Hickson, LaTonya J., Mayo Clinic, Rochester, Minnesota, United States
  • Curtis, Susan H., Mayo clinic, Rochester, Minnesota, United States
  • Beck, Annika, Mayo Clinic , Rochester, Minnesota, United States
  • Amberg, Brigid M., Mayo Clinic , Rochester, Minnesota, United States
  • Espinoza, Nataly R., Mayo Clinic , Rochester, Minnesota, United States
  • Wirtz, Cristina, Mayo Clinic , Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Clinic, Rochester, Minnesota, United States
  • Dahlen, Erin, Mayo Clinic , Rochester, Minnesota, United States
  • Shaw, Kevin, Mayo Clinic , Rochester, Minnesota, United States
  • Hargraves, Ian G., Mayo Clinic , Rochester, Minnesota, United States
  • Albright, Robert C., Mayo Clinic, Rochester, Minnesota, United States
Background

Prognostic information is key to shared decision making. Efforts are underway to enhance and implement prognostic tools for prediction of CKD progression and mortality. Whether patients are receptive and value such individualized risk predictions is unclear.

Methods

Semi-structured telephone or in-person interviews were conducted following routine visits to a multidisciplinary CKD clinic. Each patient was asked about his or her perspectives and experiences related to sharing dialysis risk prediction and prognosis with patients. Interviews were audiotaped, transcribed verbatim, and analyzed. Our team engaged in line-by-line, open, axial, and selective coding followed by content analysis.

Results

We enrolled 19 patients stage 3b-5, age 67-89 (avg. 78.57), 74% men. Often patients dreaded the possibility of starting dialysis, considering it a “last resort.” Most patients understood that dialysis would impose significant limitations on their freedom. Almost all patients reported that they wanted to receive (or would not object to) a prediction of their risk of progressing to dialysis, even if it would be “kinda scary.” Patients reported this could help them “plan for the future” and motivate them to adhere to preventive measures, but noted that the prediction might be upsetting to some. There was less agreement about the value of receiving a life expectancy prediction. Patients suggested that it should be offered only when a patient requests it or agrees to it. A life expectancy prediction would help patients “make an informed decision” about how to treat their CKD, and help them make preparations for the end of life if needed. We identified that several patients conflated the risk of progression to dialysis with the risk of death, equating refusing dialysis with rapid death.

Conclusion

This prospective patient-centered qualitative study confirms previous survey results suggesting that CKD patients are interested in prognostic information. Furthermore our findings add context and depth to the value of risk prediction in the clinical encounter and suggest ways in which to address individualized prognosis with patients. This can help further the development of intuitive shared decision making tools to relay this information to the patients who want it.

Funding

  • NIDDK Support