scholarly journals If I’m Worrying About Getting Well, How Can I Get Well? Decision-Making among African Americans with Advanced CKD

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 917-917
Author(s):  
Tyrone Hamler ◽  
Megan Schmidt-Sane ◽  
Anne Huml ◽  
Mirela Dobre ◽  
Donna Taylor
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
African Americans ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
The United States ◽  
Social Work Practice ◽  
Health Concern ◽  
Shared Decision ◽  
Older African Americans

Abstract Objectives: Chronic kidney disease (CKD) is an emerging major public health concern in the United States. Shared decision-making (SDM) has gained attention as an important area of inquiry in chronic kidney disease research. Few studies focus on shared decision-making or preferences of older African Americans during the advanced stages of CKD before the initiation of dialysis. The objective of this study was to understand decision-making preferences and shared decision-making among older African Americans with advanced chronic kidney disease who have yet to start dialysis. Methods: Data were collected from an outpatient clinic sample of older African Americans ≥ 55 years old (N = 10) diagnosed with advanced CKD. Participants were administered a survey with open-ended questions related to shared decision-making, CKD healthcare and general healthcare preferences (both open-ended and closed-ended questions), and participant characteristics. A thematic analysis framework was applied to identify themes and patterns in the data. Results: Several themes emerged in regard to shared decision-making and patient preferences including: complexity of CKD management, uncertainty of prognosis, barriers and facilitators to CKD self-management and SDM, diagnosis and dialysis information, elements of SDM, and the structural and social context of SDM related to racial inequities. Discussion: Participants identified a nuanced understanding of the concerns related to managing CKD. The complex and ever-changing nature of CKD was emphasized as participants discussed how they perceived their care needs. This study provides implications for social work practice, healthcare policy and interprofessional collaboration in the care of older African Americans.

scholarly journals The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease

PRILOZI ◽  
2016 ◽  
Vol 37 (2-3) ◽  
pp. 33-42 ◽  
Author(s):  
Marijke Stryckers ◽  
Evi V Nagler ◽  
Wim Van Biesen
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Risk Prediction ◽  
Prediction Models ◽  
Shared Decision ◽  
End Stage Kidney Disease ◽  
Risk Prediction Models ◽  
End Stage

AbstractAs people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual’s values and preferences. Accurate estimations of one’s risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

scholarly journals Shared decision-making, advance care planning for chronic kidney disease patients

2021 ◽  
Vol 27 (5) ◽  
pp. 33
Author(s):  
ShankarPrasad Nagaraju ◽  
Jayita Deodhar ◽  
AshokL Kirpalani ◽  
AjithM Nayak
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care

scholarly journals Nephrologists’ emotional burden regarding decision-making about dialysis initiation in older adults: a qualitative study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Melissa W. Wachterman ◽  
Tarikwa Leveille ◽  
Nancy L. Keating ◽  
Steven R. Simon ◽  
Sushrut S. Waikar ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Conservative Management ◽  
The United States ◽  
Structured Interview ◽  
Dialysis Initiation ◽  
Shared Decision ◽  
Emotional Burden

Abstract Background Conservative management, an approach to treating end-stage kidney disease without dialysis, while generally associated with shorter life expectancy than treatment with dialysis, is associated with fewer hospitalizations, better functional status and, potentially, better quality of life. Conservative management is a well-established treatment approach in a number of Western countries, including the United Kingdom (U.K.). In contrast, despite clinical practice guidelines in the United States (U.S.) recommending that nephrologists discuss all treatment options, including conservative management, with stage 4 and 5 chronic kidney disease patients, studies suggest that this rarely occurs. Therefore, we explored U.S. nephrologists’ approaches to decision-making about dialysis and perspectives on conservative management among older adults. Methods We conducted a qualitative research study. We interviewed 20 nephrologists – 15 from academic centers and 5 from community practices – utilizing a semi-structured interview guide containing open-ended questions. Interview transcripts were analyzed using grounded thematic analysis in which codes were generated inductively and iteratively modified, and themes were identified. Transcripts were coded independently by two investigators, and interviews were conducted until thematic saturation. Results Twenty nephrologists (85% white, 75% male, mean age 50) participated in interviews. We found that decision-making about dialysis initiation in older adults can create emotional burden for nephrologists. We identified four themes that reflected factors that contribute to this emotional burden including nephrologists’ perspectives that: 1) uncertainty exists about how a patient will do on dialysis, 2) the alternative to dialysis is death, 3) confronting death is difficult, and 4) patients do not regret initiating dialysis. Three themes revealed different decision-making strategies that nephrologists use to reduce this emotional burden: 1) convincing patients to “just do it” (i.e. dialysis), 2) shifting the decision-making responsibility to patients, and 3) utilizing time-limited trials of dialysis. Conclusions A decision not to start dialysis and instead pursue conservative management can be emotionally burdensome for nephrologists for a number of reasons including clinical uncertainty about prognosis on dialysis and discomfort with death. Nephrologists’ attempts to reduce this burden may be reflected in different decision-making styles – paternalistic, informed, and shared decision-making. Shared decision-making may relieve some of the emotional burden while preserving patient-centered care.

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