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Kidney Week

Abstract: TH-PO641

The Pitfalls of Nephrology Care: Are Older Patients and Their Caregivers Getting What They Need?

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Eneanya, Nwamaka D., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Stallings, Taylor L., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Percy, Shananssa, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Klaiman, Tamar, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Temel, Jennifer S., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Older patients with advanced chronic kidney disease lack knowledge and information regarding disease treatment and advance care planning. It is unclear whether clinicians and older patients have the same goals with regards to communication of treatment decisions and goals of care. We sought to explore perceptions of clinician behavior and patient preferences via interviews with nephrologists, primary care physicians, patients and caregivers regarding treatment for end-stage renal disease and advance care planning.

Methods

Between March 2017 and May 2018, we conducted individual semi-structured interviews with nephrologists, primary care physicians, older patients (age ≧ 65), and their caregivers. Transcripts were transcribed using TranscribeMe and reviewed in an iterative process. Using Nvivo 11, we coded all transcripts utilizing two codebooks (clinicians and patients/caregivers) and identified key themes. Three independent coders conducted thematic content analyses and discrepancies in coding were resolved through consensus coding.

Results

We interviewed 16 clinicians (nephrology, n = 8; primary care, n= 8), 10 patients, and 5 caregivers. We identified three key findings: 1) nephrologists felt their primary responsibility was to discuss dialysis and other treatments for kidney disease including conservative kidney management, 2) primary care clinicians felt that they should take the lead in helping patients navigate their disease management and also lead advance care planning discussions, and 3) patients’ and caregivers’ perspectives about dialysis, quality of life and planning ahead for their care were not adequately addressed by clinicians.

Conclusion

Our findings highlight the differences in opinions and expectations between clinicians, patients, and their caregivers regarding treatment decisions and advance care planning in nephrology. Importantly, patients and caregivers do not feel that their needs are being met. Further research is needed to test feasible models of patient-centered education to ensure all stakeholders feel valued.

Funding

  • NIDDK Support