scholarly journals Self-referral of Chinese patients with advanced chronic kidney disease and treatment decision-making: A qualitative study

2020 ◽  
Author(s):  
Yajing Gao ◽  
Yan Shan ◽  
Tingting Jiang ◽  
Xue Li ◽  
Xinxin Jiang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Negative Emotion ◽  
Treatment Decision ◽  
Chinese Patients ◽  
Structured Interviews ◽  
Advanced Chronic Kidney Disease ◽  
Treatment Decision Making ◽  
Referral Decision

Abstract: Rationale, aims, and objectives: Chinese patients with advanced chronic kidney disease (CKD), especially rural patients possibly occur self-referral behavior and then treatment decisions followed. It is unclear the relationship between self-referral and treatment decision-making. Thus, the aim of this study was to explore the perceptions and views of self-referral and treatment decision making among patients with advanced chronic kidney disease. Methods: We conducted semi-structured interviews with 26 patients with advanced kidney disease and 12 nephrologists. Interviews were conducted and analyzed thematically until reaching thematic saturation. Results: We identified three themes reflected: 1) self-referral decision making (self-referral motive, barrier to self-referral, seeking for self-referral information); 2) the views and experience of self-referral care (facilitating shared decision making, imposing psychological pressure, feeling about self-referral communication, challenge to staff-patient relationship); 3) treatment decision making (decisional awareness and roles, cost-benefit trade-off and redicision). Conclusions: Our study identified that organizational and demographic factors, self-referral motives worked together at the self-referral decision-making and treatment decision-making when advanced CKD patients facing with healthcare facilities and treatment options. Those findings suggest stakeholders should accelerate the popularization of peritoneal dialysis technology and establish the CKD screening and management systems. For self-referral patients with advanced CKD, our results suggest specialized dialysis transition care to improve quality of communication and soothe patients’ negative emotion.

scholarly journals Self-referral of Chinese patients with advanced chronic kidney disease and treatment decision-making: A qualitative study

2020 ◽  
Author(s):  
Ya jing Gao ◽  
Yan Shan ◽  
Yue Zhou ◽  
Ting ting Jiang ◽  
Xue Li ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Health Care Professionals ◽  
Negative Emotion ◽  
Treatment Decision ◽  
Chinese Patients ◽  
Advanced Chronic Kidney Disease ◽  
Treatment Decision Making ◽  
Referral Decision

Abstract Background: Chinese patients with advanced chronic kidney disease, especially rural patients possibly occur self-referral behavior and then treatment decisions followed. It is unclear the relationship between self-referral and treatment decision-making. Thus, the aim of this study was to explore HCPs and patient with advanced CKD perceptions of self-referral and treatment decision making. Methods: We conducted semi-structured interviews with 22 patients with advanced kidney disease and 8 health care professionals. Interviews were conducted and analyzed thematically until reaching thematic saturation. Results: We identified three themes reflected: 1) self-referral decision making (self-referral motive, barrier to self-referral, seeking for self-referral information); 2) the views and experience of self-referral care (facilitating shared decision making, imposing psychological pressure, feeling about self-referral communication, challenge to staff-patient relationship); 3) treatment decision making (decisional awareness and roles, cost-benefit trade-off and redicision). Conclusions: Our study identified that organizational and demographic factors, self-referral motives worked together at the self-referral decision-making and treatment decision-making when advanced CKD patients facing with healthcare facilities and treatment options. Those findings suggest stakeholders should accelerate the popularization of peritoneal dialysis technology and establish the CKD screening and management systems. For self-referral patients with advanced CKD, our results suggest specialized dialysis transition care to improve quality of communication and soothe patients’ negative emotion.

scholarly journals Predicting mortality risk on dialysis and conservative care: development and internal validation of a prediction tool for older patients with advanced chronic kidney disease

2020 ◽  
Author(s):  
Chava L Ramspek ◽  
Wouter R Verberne ◽  
Marjolijn van Buren ◽  
Friedo W Dekker ◽  
Willem Jan W Bos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Older Patients ◽  
Treatment Decision ◽  
Prediction Tool ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Ckd Stage

Abstract Background Conservative care (CC) may be a valid alternative to dialysis for certain older patients with advanced chronic kidney disease (CKD). A model that predicts patient prognosis on both treatment pathways could be of value in shared decision-making. Therefore, the aim is to develop a prediction tool that predicts the mortality risk for the same patient for both dialysis and CC from the time of treatment decision. Methods CKD Stage 4/5 patients aged ≥70 years, treated at a single centre in the Netherlands, were included between 2004 and 2016. Predictors were collected at treatment decision and selected based on literature and an expert panel. Outcome was 2-year mortality. Basic and extended logistic regression models were developed for both the dialysis and CC groups. These models were internally validated with bootstrapping. Model performance was assessed with discrimination and calibration. Results In total, 366 patients were included, of which 126 chose CC. Pre-selected predictors for the basic model were age, estimated glomerular filtration rate, malignancy and cardiovascular disease. Discrimination was moderate, with optimism-corrected C-statistics ranging from 0.675 to 0.750. Calibration plots showed good calibration. Conclusions A prediction tool that predicts 2-year mortality was developed to provide older advanced CKD patients with individualized prognosis estimates for both dialysis and CC. Future studies are needed to test whether our findings hold in other CKD populations. Following external validation, this prediction tool could be used to compare a patient’s prognosis on both dialysis and CC, and help to inform treatment decision-making.

Information behaviour and decision-making in patients during their cancer journey

2017 ◽  
Vol 35 (3) ◽  
pp. 494-506 ◽  
Author(s):  
Shih-Chuan Chen
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Information Source ◽  
Alternative Therapy ◽  
Treatment Decision ◽  
Treatment Method ◽  
Structured Interviews ◽  
Content Type ◽  
Information Behaviour ◽  
Treatment Decision Making

Purpose This paper aims to investigate the effect of cancer patients’ information behaviour on their decision-making at the diagnosis and treatment stages of their cancer journey. Patients’ information sources and their decision-making approaches were analyzed. Design/methodology/approach Semi-structured interviews were conducted with 15 participants. Findings The cancer patients sought information from various sources in choosing a hospital, physician, treatment method, diet and alternative therapy. Physicians were the primary information source. The patients’ approaches to treatment decision-making were diverse. An informed approach was adopted by nine patients, a paternalistic approach by four and a shared decision-making approach by only two. Practical implications In practice, the findings may assist hospitals and medical professionals in fostering pertinent interactions with patients. Originality/value The findings can enhance researcher understanding regarding the effect of cancer patients’ information behaviour on their decision-making.

Pretransplant Comprehensive Geriatric Assessment in Older Patients with Advanced Chronic Kidney Disease

Nephron ◽  
2021 ◽  
pp. 1-10
Author(s):  
Teddy Novais ◽  
Elodie Pongan ◽  
Frederic Gervais ◽  
Marie-Hélène Coste ◽  
Emmanuel Morelon ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Physical Function ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Patients ◽  
Advanced Chronic Kidney Disease ◽  
Comorbidity Burden

<b><i>Background:</i></b> In older patients with advanced chronic kidney disease (CKD), the decision of kidney transplantation (KT) is a challenge for nephrologists. The use of comprehensive geriatric assessment (CGA) is increasingly gaining interest into the process of decision-making about treatment modality choice for CKD. The aim of this study was to assess the prevalence of geriatric impairment and frailty in older dialysis and nondialysis patients with advanced CKD using a pretransplant CGA model and to identify geriatric impairments influencing the geriatricians’ recommendations for KT. <b><i>Methods:</i></b> An observational study was conducted with retrospective data from July 2017 to January 2020. Patients aged ≥65 years with advanced CKD, treated or not with dialysis, and referred by the nephrologist were included in the study. The CGA assessed comorbidity burden, cognition, mood, nutritional status, (instrumental) activities of daily living, physical function, frailty, and polypharmacy. Geriatric impairments influencing the geriatricians’ recommendations for KT were identified using univariate and multivariate logistic regressions. <b><i>Results:</i></b> 156 patients were included (74.2 ± 3.5 years and 62.2% on dialysis). Geriatric conditions were highly prevalent in both dialysis and nondialysis groups. The rate of geriatric impairments was higher in dialysis patients regarding comorbidity burden, symptoms of depression, physical function, autonomy, and frailty. Geriatrician’s recommendations for KT were as follows: favorable (79.5%) versus not favorable or multidisciplinary discussion needed with nephrologists (20.5%). Dependence for Instrumental Activities of Daily Living (IADL) (odds ratio [OR] = 3.01 and 95% confidence interval [CI] = 1.30–7.31), physical functions (OR = 2.91 and 95% CI = 1.08–7.87), and frailty (OR = 2.66 and 95% CI = 1.07–6.65) were found to be independent geriatric impairments influencing geriatrician’s recommendations for KT. <b><i>Conclusions:</i></b> Understanding the burden of geriatric impairment provides an opportunity to direct KT decision-making and to guide interventions to prevent functional decline and preserve quality of life.

scholarly journals The cultural and structural influences that ‘hide’ information from women diagnosed with breast cancer in Ghana: an ethnography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linda Serwaa Agyemang ◽  
Claire Foster ◽  
Chris McLean ◽  
Deborah Fenlon ◽  
Richard Wagland
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cultural Influences ◽  
Language Barriers ◽  
Treatment Decision ◽  
Cultural Factors ◽  
Structured Interviews ◽  
Financial Barriers ◽  
Essential Information ◽  
Treatment Decision Making

Abstract Background Socio-cultural factors may influence the uptake of breast cancer treatments. This study aimed to explore these socio-cultural influences on treatment decision-making for women in Ghana. Method An ethnographic approach was adopted. Observation was conducted of women newly diagnosed with breast cancer, nominated relatives, nurses and doctors at a breast clinic in Ghana. Semi-structured interviews followed participant observation. Thematic analysis was employed. Findings Over 16 weeks (July 2017–November 2017), 31 participants were observed and 29 took part in semi-structured interviews. Three overarching themes were identified: (1) unequal power relationships; (2) Language barriers and (3) structural constraints. Following a breast cancer diagnosis, essential information necessary for treatment decision making is ‘hidden’ from women due to an unequal patient-provider relationship. Patients acknowledged cultural behaviours of deference to experts. Doctors deliberately misrepresented treatment information to women to encourage them to undergo surgical treatment. Structural issues such as the lack of privacy during consultations hindered quality patient engagement with decision-making. High treatment costs and the lack of resources to assist women with fertility after treatment impeded open discussions around these issues. Language barriers included a lack of terms in the local Twi language to explain cancer and its treatment. There was also an absence of appropriate information materials. Conclusion Findings highlight the need for health professionals to be aware of the socio-cultural factors that limit access to quality information which is needed for informed treatment decision making. Policies that aim to provide adequate logistics; increase staffing levels; improve staff cultural awareness training and remove financial barriers are recommended.

Desire for Information and Involvement in Treatment Decisions: Elderly Cancer Patients' Preferences and Their Physicians' Perceptions

2007 ◽  
Vol 25 (33) ◽  
pp. 5275-5280 ◽  
Author(s):  
Elena B. Elkin ◽  
Susie H.M. Kim ◽  
Ephraim S. Casper ◽  
David W. Kissane ◽  
Deborah Schrag
Keyword(s):  
Decision Making ◽  
Patient Preferences ◽  
Treatment Decision ◽  
Active Role ◽  
Treatment Decisions ◽  
Structured Interviews ◽  
Prognostic Information ◽  
Treatment Decision Making ◽  
Oncology Practice ◽  
Contemporary Medicine

Purpose Shared decision making is a tenet of contemporary medicine and oncology practice. How involved elderly patients want to be in making treatment decisions and how physicians perceive patient preferences for such involvement are uncertain. Patients and Methods In structured interviews about multiple facets of chemotherapy treatment decision making, we asked patients age 70 years and older with a recent diagnosis of metastatic colorectal cancer (CRC) about their preferences for prognostic information and for involvement in treatment decision making. We also asked treating oncologists (n = 19) to describe their perceptions of patient preferences. Information and decision-making preferences were evaluated in relation to sociodemographic and clinical characteristics. Results Seventy-three patients age 70 to 89 years completed the study interview within 16 weeks of metastatic CRC diagnosis. Most patients (n = 70; 96%) had decided to receive chemotherapy and 61 had initiated treatment. Relatively few (n = 32; 44%) wanted information about expected survival when they made a treatment decision. Preference for prognostic information was more common among men than women (56% v 29%; P < .05). About half of the patients (n = 38; 52%) preferred a passive role in the treatment decision-making process. Physician perceptions were concordant with patient preferences for information in 44% of patient-physician pairs and for decision control in 41% of patient-physician pairs. Conclusion For older patients with advanced CRC, preferences for prognostic information and for an active role in treatment decision making are not easily predictable. Physicians' perceptions are often inconsistent with patients' stated preferences. Explicit discussion of preferred decision-making styles may improve patient-physician encounters.

scholarly journals Exploring the Experiences of Adults With Microtia: A Qualitative Study

2020 ◽  
Vol 57 (10) ◽  
pp. 1230-1237
Author(s):  
Claire Hamlet ◽  
Diana Harcourt
Keyword(s):  
Decision Making ◽  
Negative Impact ◽  
Treatment Decision ◽  
Improve Patient Care ◽  
Psychosocial Interventions ◽  
Romantic Partners ◽  
Future Research ◽  
Ear Reconstruction ◽  
Structured Interviews ◽  
Treatment Decision Making

Objective: Microtia is a medically complex condition, with the option of surgery to address hearing and reconstruct the ear. The current study explored adults’ experiences of microtia, with a particular focus on the psychosocial impact and experiences of ear reconstruction. The ultimate aim was to identify areas for support and future research that could improve patient care. Design: Fifteen adults (12 females) aged between 20 and 62 years took part in semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results: Three main themes were identified in the data: microtia as an invisible difference, surgery as a welcome opportunity, and living well with microtia. Participants had incorporated microtia into their self-concept and did not report a lasting negative impact on their lives. However, some psychosocial challenges were reported, including anxiety about showing their ears (even after reconstruction), disclosing their diagnosis to romantic partners, surgical decision-making, and feeling unsupported in the work environment. Conclusion: Individuals with microtia may benefit from psychosocial interventions to increase confidence, access to support for treatment decision-making, and guidance around disclosing microtia to employers.

scholarly journals The transition clinic in chronic kidney disease care

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii4-ii10 ◽  
Author(s):  
Marie Evans ◽  
Kai Lopau
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Patient Involvement ◽  
Decision Making Process ◽  
Shared Decision ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Transition Clinic ◽  
Chronic Kidney Disease Care

Abstract People with advanced chronic kidney disease and evidence of progression have a high risk of renal replacement therapy. Specialized transition clinics could offer a better option for preparing these patients for dialysis, transplantation or conservative care. This review focuses on the different aspects of such transition clinics. We discuss which patients should be referred to these units and when referral should take place. Patient involvement in the decision-making process is important and requires unbiased patient education. There are many themes, both patient-centred and within the healthcare structure, that will influence the process of shared decision-making and the modality choice. Aspects of placing an access for haemodialysis and peritoneal dialysis are reviewed. Finally, we discuss the importance of pre-emptive transplantation and a planned dialysis start, all with a focus on multidisciplinary collaboration at the transition clinic.

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