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Understanding by older patients of dialysis and conservative management for chronic kidney failure.

Tonkin-Crine, Sarah and Okamoto, Ikumi and Leydon, Geraldine M and Murtagh, Fliss E M and Farrington, Ken and Caskey, Fergus and Rayner, Hugh C and Roderick, Paul (2015) Understanding by older patients of dialysis and conservative management for chronic kidney failure. American journal of kidney diseases : the official journal of the National Kidney Foundation, 65 (3). pp. 443-450. ISSN 1523-6838. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login ID's.

Full text not available from this repository.
Official URL: http://www.ajkd.org/article/S0272-6386(14)01166-4/...

Abstract

BACKGROUND

Older adults with chronic kidney disease stage 5 may be offered a choice between dialysis and conservative management. Few studies have explored patients' reasons for choosing conservative management and none have compared the views of those who have chosen different treatments across renal units.

STUDY DESIGN

Qualitative study with semistructured interviews.

SETTINGS & PARTICIPANTS

Patients 75 years or older recruited from 9 renal units. Units were chosen to reflect variation in the scale of delivery of conservative management.

METHODOLOGY

Semistructured interviews audiorecorded and transcribed verbatim.

ANALYTICAL APPROACH

Data were analyzed using thematic analysis.

RESULTS

42 interviews were completed, 4 to 6 per renal unit. Patients were sampled from those receiving dialysis, those preparing for dialysis, and those choosing conservative management. 14 patients in each group were interviewed. Patients who had chosen different treatments held varying beliefs about what dialysis could offer. The information that patients reported receiving from clinical staff differed between units. Patients from units with a more established conservative management pathway were more aware of conservative management, less often believed that dialysis would guarantee longevity, and more often had discussed the future with staff. Some patients receiving conservative management reported that they would have dialysis if they became unwell in the future, indicating the conditional nature of their decision.

LIMITATIONS

Recruitment of older adults with frailty and comorbid conditions was difficult and therefore transferability of findings to this population is limited.

CONCLUSIONS

Older adults with chronic kidney disease stage 5 who have chosen different treatment options have contrasting beliefs about the likely outcomes of dialysis for those who are influenced by information provided by renal units. Supporting renal staff in discussing conservative management as a valid alternative to dialysis for a subset of patients will aid informed decision making. There is a need for better evidence about conservative management to support shared decision making for older people with chronic kidney failure.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login ID's.
Subjects: WJ Urogenital system. Urology
Divisions: Emergency Services > Renal
Related URLs:
Depositing User: Miss Adele Stanton
Date Deposited: 30 May 2015 06:43
Last Modified: 30 May 2015 06:43
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/824

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