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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Abstract: PO0057

Decision-Making During Uncertain Times: A Qualitative Study of Kidney Patients, Care Partners, and Nephrologists During the COVID-19 Pandemic

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Porteny, Thalia, Tufts University, Medford, Massachusetts, United States
  • Koch-Weser, Susan, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Rifkin, Dena E., University of California San Diego, La Jolla, California, United States
  • Isakova, Tamara, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Gordon, Elisa J., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Wong, John B., Tufts Medical Center, Boston, Massachusetts, United States
  • Rossi, Ana Paula, Piedmont Healthcare Inc, Atlanta, Georgia, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Ladin, Keren, Tufts University, Medford, Massachusetts, United States

Group or Team Name

  • DART Investigators
Background

Older adults faced treatment decisions for kidney failure during the COVID-pandemic, despite high risk of hospitalization, intensive care, and death. Given heightened uncertainty, clinicians needed to adapt communication about risks, benefits, and treatment decisions during the COVID-19 pandemic. Understanding how to support decision-making during uncertain times can guide clinicians in future public health crises.

Methods

Qualitative study using semi-structured interviews (August-December 2020) with CKD stage 4-5 patients, age 70+, carepartners, and clinicians in Boston, Portland, Maine, San Diego, and Chicago. Thematic analyses were conducted.

Results

Among 76 participants (39 patients, 17 carepartners, 20 clinicians) 13 patients (33%) identified as Black, and 7 (18%) were receiving dialysis. Four themes characterized treatment decision-making during the COVID-19 pandemic: Difficulty communicatng risk: balancing hope with caution; Clinicians' increased support for home dialysis; Patient confidence in chosen modality; and Coping with uncertainty and isolation in CKD.

Clinicians struggled to balance discussion of COVID-19 risks while preserving hope. Black patients reported fewer conversations about COVID-19 risks than White patients and had more unaddressed questions. Clinicians reported being more open to home dialysis than pre-COVID-19. While some patients expressed interested in conservative management, few clinicians offered conservative management as an option. All patients who had initiated treatment prior to COVID-19, irrespective of modality, believed that their treatment was safest and optimal during the pandemic. With few clinical converations incorporating COVID-19-specific risks, patients and carepartners struggled to cope, finding both in-person and telehealth visits safe but isolating.

Conclusion

Although clinicians struggled communicating about COVID-19 leaving patients with unadressed concerns, patients across modalities felt safe and confident in their treatment. Clinicians developed an openness to home dialysis, though few offered conservative management despite patient preferences. Research should examine optimal approaches to enhance communication and shared-decision making to prepare for future systemic challenges.

Funding

  • Private Foundation Support