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Abstract: PO1098

Nephrologists' Practices, Perspectives, and Experiences Providing Care and Treatment Education to Patients with Varying Amounts of Pre-ESRD Care: A Mixed-Methods Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Urbanski, Megan, Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States
  • Gadegbeku, Crystal A., Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Siminoff, Laura A., Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States
  • Waterman, Amy D., Transplant Research and Education Center, UCLA, Los Angeles, California, United States
  • Dumenci, Levent, Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States
  • Gardiner, Heather Marie, Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States
Background

A third of patients newly diagnosed with end-stage renal disease (ESRD) in the U.S. had minimal or no pre-ESRD nephrology care and “crashed” onto dialysis. Little is known about treating nephrologists’ practices and perspectives on renal replacement therapy (RRT) information delivery and decision-making for this subset of patients at the time of their ESRD diagnosis and RRT initiation.

Methods

A convergent mixed methods study design was used, and semi-structured interviews were conducted with nephrologists in Philadelphia and the surrounding region. Participants were queried on general practices and perspectives on RRT information delivery and decision-making practices for patients with varying amounts of pre-ESRD nephrology care and also queried on their experiences providing care to patients recently diagnosed with ESRD. Applied thematic analysis was used to analyze the qualitative responses and all quantitative data were fully described.

Results

A total of 15 nephrologists participated. Participants had been practicing nephrology for a median of 7 years and a third of participants were trainees at the time of the interview (i.e., nephrology fellows). The qualitative analyses revealed 12 themes, including: patients’ clinical presentation guides RRT initiation, RRT initiation often occurs urgently irrespective of pre-ESRD care, utilize direct communication style during diagnosis, reliance on other providers for patient education, challenges to providing patient education, desire improved access to educational resources, and desire engaging patient in shared decision-making for RRT selection and initiation. Notably, participants identified patient- and institutional-level barriers inhibiting their ability to provide quality care and education to patients presenting with ESRD diagnosis for RRT initiation.

Conclusion

Nephrologists face significant challenges in providing quality care to patients with varying amounts of pre-ESRD nephrology care. Increasing availability of nephrology-trained interdisciplinary staff in outpatient chronic kidney disease clinics and hospital settings to assist providers with the logistics associated with RRT education and initiation has the potential to improve care for patients newly diagnosed with ESRD.

Funding

  • NIDDK Support