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Abstract: TH-PO783

Older Patients' and Caregivers' Perspectives on Kidney Therapy Decision-Making

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Sampath, Ramya, University of Rochester Medical Center, Rochester, New York, United States
  • Seshadri, Sandhya, University of Rochester Medical Center, Rochester, New York, United States
  • Phan, Tramanh, University of Rochester Medical Center, Rochester, New York, United States
  • Duberstein, Paul, Rutgers School of Public Health, Piscataway, New Jersey, United States
  • Epstein, Ronald M., University of Rochester Medical Center, Rochester, New York, United States
  • Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States
Background

Growing evidence suggests that dialysis may not significantly improve survival or quality of life (QOL) for some older, frail patients with significant comorbidities. Studies also suggest that decisions to initiate dialysis are not always concordant with patients’ expressed treatment preferences. Thus, it is critical to gain knowledge of patients’ and their caregivers’ perspectives on kidney therapy (KT) decision-making. Our study describes the perceptions and preferences of older adults and their caregivers during KT decision-making.

Methods

We designed a survey and administered it orally to ascertain patients’ and caregivers’ perceptions and preferences regarding KT decisions. Our sample included 26 patients and 15 caregivers enrolled in the intervention arm of the CKD-EDU Study, a palliative care intervention to help older adults and their caregivers with KT decision-making. Using qualitative content analysis, four study team members individually coded the data and met regularly to review the coded data. Consistent with qualitative research methods, differences were resolved through discussion and consensus to enhance rigor.

Results

The average ages of patients and caregivers were 82.7± 5.7 years and 66.4 ± 13.7 years respectively. Thirteen patients and eleven caregivers were women; twenty patients and twelve caregivers were White. Four overarching themes of patient and caregiver perceptions and preferences regarding KT decision-making emerged: 1) It is important for patients to both prolong life and have good a quality of life; 2) Some patients’ desires for longevity conflicted with their preferred treatment choices; 3) Thoughts of CKD progression and consequences of treatment options on QOL were worrisome; 4) “Deciding not to decide” was a common way to cope with stressors of decision-making and to maintain a sense of control.

Conclusion

Patients’ and caregivers’ preferences for KT options are multifaceted and affect-laden. Improved communication and shared decision-making to improve KT decision-making are necessary to ensure goal-concordant care for older adults.

Funding

  • Other NIH Support