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Abstract: TH-PO772

Informed Kidney Therapy Decision Making for Patients With ESKD Receiving Maintenance Dialysis: What Do Patients Say?

Session Information

Category: Geriatric Nephrology

  • 1200 Geriatric Nephrology

Authors

  • Dahl, Spencer, University of Rochester Medical Center, Rochester, New York, United States
  • Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States
Background

Informed decision making has legal and ethical implications for the kidney therapy (KT) decision-making process. However, previous small scale studies suggest significant lapses in informed decision making for people receiving dialysis. To advance the field, we undertook the current study examining patient’s recall of various aspects of informed decision making during KT decisions.

Methods

We surveyed 223 hospitalized patients (223/578, 59% response rate) receiving maintenance dialysis at an academic tertiary care hospital in upstate New York. We assessed informed KT decision making using a previously published informed KT decision making questionnaire1. We present descriptive analyses of our findings.

Results

The mean age of the respondents was 68 years (SD ±15.4), 50% had attained a high school level education or lower, 39% were Black, 24% White non-Hispanic, and 21% of Hispanic or Latino origin. Patients had been receiving dialysis treatment for an average of 3.1 years (SD ±2.4). Patient’s responses are grouped into three categories: (1) dialysis knowledge and (2) decision making, and (3) prognosis.

In response to questions about disease knowledge, 41% of patients responded “No” to whether they had been informed about the condition that led to kidney failure, 40% were not informed of dialysis options such as peritoneal and hemodialysis, and 57% were not aware of the potential benefits and burdens of each option. Regarding decision making, nearly 71% reported that conservative kidney management was never presented as an option, and 78% did not recall being informed of the option to withdraw from dialysis. In response to questions about prognostic awareness, 53% did not report being informed about life expectancy with and without dialysis, and 38% did not recall an explanation for how their daily life might change after initiating dialysis.

Conclusion

An assessment of informed decision making among hospitalized patients receiving maintenance dialysis revealed significant lapses in the informed decision making process. Interventions to improve informed decision making in people with CKD are urgently needed.

Citations:
1: Song MK, Lin FC, Gilet CA, Arnold RM, Bridgman JC, Ward SE. Patient perspectives on informed decision-making surrounding dialysis initiation. Nephrology Dialysis Transplantation. 2013;28(11):2815-2823.