Patient Perspectives on the Choice of Dialysis Modality: Results From the Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT) Study

详细信息    查看全文

• 作者：Claudia Dahlerus ; PhD¹ ; ^&lowast ; ; Martha Quinn ; MPH² ; ^&lowast ; ; Emily Messersmith ; PhD³ ; Laurie Lachance ; PhD² ; Lalita Subramanian ; PhD³ ; Erica Perry ; MSW⁴ ; ⁵ ; Jill Cole ; LMSW⁵ ; ⁶ ; Junhui Zhao ; PhD³ ; Celeste Lee ; BA⁷ ; Margie McCall ; BA⁸ ; Leslie Paulson ; MSW⁹ ; Francesca Tentori ; MD³ ; ¹⁰ ; ^{francesca.tentori@arborresearch.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Hemodialysis (HD) ; peritoneal dialysis (PD) ; dialysis choice ; modality selection ; patient perspectives ; shared decision making ; patient-centered care ; patient priorities ; decision aid tool development ; renal replacement therapy (RRT) ; end-stage renal disease (ESRD) ; chronic kidney disease (CKD) ; qualitative research
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：68
• 期：6
• 页码：901-910
• 全文大小：396 K

文摘

Little is known about factors that are important to patients with advanced kidney disease and their perspectives at the time they choose a dialysis modality. EPOCH-RRT, a study supported in part by the Patient-Centered Outcomes Research Institute (PCORI), was designed to assist patients with this choice by identifying such factors and effectively provide relevant information.

Study Design

Cross-sectional study, designed and conducted in collaboration with a multistakeholder advisory panel that included patients, caregivers, and health care professionals.

Setting & Participants

180 patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate < 25 mL/min/1.73 m²), either non−dialysis-dependent (NDD-CKD; n = 65) or on dialysis therapy (hemodialysis [HD], n = 77; or peritoneal dialysis, n = 38), recruited across the United States through social media and in-person contacts.

Methodology

Semistructured telephone interviews including open- and closed-ended questions.

Analytical Approach

Mixed methods, integrating quantitative and qualitative approaches; themes identified through content analysis of interview transcripts by 2 independent coders.

Results

Themes most often reported as important were keeping as much independence as possible, quality and quantity of life, and flexibility in daily schedule. Other factors (eg, concern about the way they look) differed across patient subgroups based on age, sex, and NDD-CKD/dialysis modality. Among patients who had initiated dialysis therapy, almost half (47%) the HD patients believed that the decision to be treated by HD had largely not been their choice; this was only reported by 3% of peritoneal dialysis patients.

Limitations

Recruitment through social media and willingness to participate in lengthy telephone interviews resulted in a select sample that may not be representative of the broader advanced CKD population; therefore, generalizability of findings cannot be determined.

Conclusions

Incorporation of patient priorities in care improves health outcomes. Given the perceived limited role in the choice of dialysis treatment, our findings support the need for interventions to improve shared decision making on dialysis treatment options, targeting both patients and clinicians.