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Kidney Week

Abstract: FR-PO887

Nephrology Providers' Experiences with Discussing the Option of Forgoing Kidney Replacement Therapy with Patients

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Lee, Deborah, Virginia Mason Franciscan Health, Seattle, Washington, United States
  • Chotivatanapong, Julie, University of Washington, Seattle, Washington, United States
  • Prince, David K., University of Washington, Seattle, Washington, United States
  • Wong, Susan P.Y., University of Washington, Seattle, Washington, United States
Background

Understanding how nephrology providers discuss therapeutic alternatives to kidney replacement therapy (KRT) for advanced kidney disease is paramount to supporting efforts to improve shared decision-making with patients.

Methods

We conducted a cross-sectional survey study of national sample of nephrology providers recruited through US professional societies between March-July 2022 about their experiences caring for patients who forgo KRT. We invited a random sample of survey respondents to complete follow-up qualitative interviews between August-October 2022 about their experiences discussing this option with patients.

Results

Overall, 203 nephrology providers (age 47±12 years, 66.0% female, 53.2% white), of which 49.8% were nephrologists and 50.2% were advanced practice providers completed the survey. The terms “active medical management without dialysis” (44.4%) and “conservative kidney management” (12.0%) were rated “overall best” in conveying the approach to care for patients who forgo KRT. From interviews with 21 (age 54±13 years, 81.0% female, 57.1% white) survey respondents, 3 dominant themes reflecting experiences with discussing this option with patients emerged: 1) Terminology used: there was inconsistency in the terms used to describe this option across different providers, the terms used by the same provider with different audiences, and the meaning of the same term to different providers; 2) Interpreting patients’ expressed preferences: when patients communicated a desire not to receive KRT, providers were unsure whether patients truly meant to never pursue KRT and whether patients were likely to change their minds; and, 3) Sharing decision-making: providers spoke to challenges with negotiating respect for patients’ autonomy, perceived best interests for the patient, and influences from family members when counseling patients about decisions to forgo KRT.

Conclusion

There is substantial inconsistency and ambiguity in providers’ discussions with patients about care for patients who forgo KRT. Our findings highlight a need to build professional consensus on language used to discuss this option and for additional tools to assist providers with navigating these discussions.

Funding

  • Private Foundation Support