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Kidney Week

Abstract: PO1699

Perspectives on Conservative Management of Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Wong, Susan P.Y., University of Washington, Seattle, Washington, United States
  • Oestreich, Taryn, University of Washington, Seattle, Washington, United States
  • Sayre, George G., University of Washington, Seattle, Washington, United States
  • O'Hare, Ann M., University of Washington, Seattle, Washington, United States
  • Curtis, J. Randall, University of Washington, Seattle, Washington, United States
Background

Growing recognition of the limits of maintenance dialysis for some groups of patients has led to the emergence of conservative care models for advanced kidney disease in several countries outside the US. There is strong interest in replicating similar models in the US, however little is known about how these models are perceived by US patients and family members.

Methods

We conducted a qualitative study using cognitive interviews with 14 patients aged ≥75 years with advanced kidney disease and 6 of their family members about their perception of conservative care approaches in other countries as described in available patient decision aids on treatment of advanced kidney disease. We performed an inductive thematic analysis of interviews to identify themes reflecting participants’ understanding and receptivity to conservative care.

Results

Subjects were mostly white (n=15) and had at least some college education (n=16). 4 prominent themes emerged from analysis of interviews: 1) Core elements of conservative care: aspects of conservative care that were appealing to participants included a whole-person, multidisciplinary approach to care that focused on symptom management, maintaining current lifestyle and managing health setbacks; 2) Importance of how conservative care is framed: participants were more receptive to conservative care when this was framed as an active rather than passive treatment approach and were accepting of uncertainty in disease prognosis; 3) An explicit approach to shared decision-making: participants believed decisions about conservative care or dialysis address considerations about risk and benefits of treatment options, family and clinician perspectives and personal goals, values and preferences; and, 4) Relationship between conservative care and dialysis: although conservative care models outside the US are generally intended to serve as an alternative to dialysis, participants’ comments implied that they did not view conservative care and dialysis as mutually exclusive

Conclusion

Although participants in this study found many aspects of conservative care models developed in other countries to be appealing, models will likely require adaptation to meet the needs and preferences of US patients and their families.

Funding

  • Private Foundation Support