A Qualitative Pilot Study of the Perceptions  in Older Adults with End-Stage Kidney Disease  on Hemodialysis*

BackgroundLittle is known about the perceptions of older adults with end-stage kidney disease (ESKD) on chronic hemodialysis (HD) even though this could potentially influence how treatment is received. This study explores the perceptions of older adults with ESKD on HD, specifically their decision to initiate HD, preconceptions and expectations of HD, perceived difficulties with HD, and coping strategies.Design: Cross–sectionalSetting: Outpatient chronic dialysis units Participants: Older adults with ESKD on HD Intervention: Open-ended interviews were conducted with 15 participants. Inclusion criteria were age 60 years and older, HD duration of at least three months, and ability to consent and participate in the interview process.Results: We report on four identified domains: decision to initiate HD; preconceptions and expectations of HD; drawback of HD; and coping strategies. All participants were reluctant to initiate HD, but made the decision on advice from their physicians for varying reasons. Trust in physicians’ opinions also played a role for some. Some participants had positive preconceptions of HD, while a few had negative preconceptions or unrealistic expectations. Even though the majority of participants identified several difficulties with being on HD, they also had positive coping strategies, and the majority indicated that they would make the same decision to initiate HD.Conclusion: As clinicians are turning more to patient-centered medicine, understanding patients’ perceptions of HD is of crucial importance. Our study highlights the importance of improving pre-hemodialysis education to ensure that patients’ expectations are realistic, as well as identifying individualized coping strategies by patients.

Download Full-text

A Randomized Controlled Trial to Evaluate and Assess the Effect of Comprehensive Pre-End Stage Kidney Disease Education on Home Dialysis Use in Veterans, Rationale and Design

10.21203/rs.3.rs-412522/v1 ◽

2021 ◽

Author(s):

Ashutosh M. Shukla ◽

Jennifer Hale-Gallardo ◽

Tatiana Orozco ◽

Ivette Freytes ◽

Sergio Romero ◽

...

Keyword(s):

Kidney Disease ◽

Controlled Trial ◽

End Stage Kidney Disease ◽

Patient Centered ◽

Advanced Chronic Kidney Disease ◽

Home Dialysis ◽

Clinical Patient ◽

Randomized Controlled ◽

The Us ◽

End Stage

Abstract Background Informed dialysis selection and greater home dialysis use are the two long-desired, underachieved targets of advanced chronic kidney disease care in the US healthcare system. Observational institutional studies have shown that comprehensive pre-end stage kidney disease (ESKD) disease education (CPE) can improve both these outcomes. However, lack of validated protocols, well-controlled studies, and systemic models have limited wide-spread adoption of CPE in the US. We hypothesized that a universal CPE and patient-centered initiation of renal replacement therapy can improve multiple clinical, patient-centered and health service outcomes in advanced chronic kidney disease (CKD) and ESKD.Methods Trial to Evaluate and Assess the effects of CPE on Home dialysis in Veterans (TEACH-VET) is a mixed method randomized controlled trial aimed to evaluate the effects of a system-based approach for providing CPE to all Veterans with advanced CKD across a regional healthcare System. The study will randomize 544 Veterans with non-dialysis stage 4 and 5 CKD in a 1:1 allocation stratified by their annual family income and the stage of CKD to an intervention (CPE) arm or control arm. Intervention arm will receive a two-phase CPE in an intent-to-teach manner. Control arm will receive usual clinical care supplemented by resources for the freely-available kidney disease information. Participants will be followed after intervention/control for the duration of the study or until 90-days post-ESKD, whichever occurs earlier.Results The primary outcome will assess the proportion of Veterans using home dialysis at 90-days post-ESKD, and secondary outcomes will include post-intervention/control CKD knowledge, confidence in dialysis decision and home dialysis selection. Qualitative arm of the study will use semi-structured interviews to in-depth assess Veterans’ satisfaction with the intervention, preference for delivery, and barriers and facilitators to home dialysis selection and use. Several post-ESKD clinical, patient-centered and health services outcomes will be assessed 90-days post-ESKD as additional secondary outcomes.Conclusion The results will provide evidence regarding the need and efficacy of a system-based, patient-centered approach towards universal CPE for all patients with advanced CKD. If successful, this may provide a blueprint for developing such programs across the similar healthcare infrastructures throughout the country.Trial registration: NCT04064086

Download Full-text

Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis

PLoS ONE ◽

10.1371/journal.pone.0217787 ◽

2019 ◽

Vol 14 (5) ◽

pp. e0217787 ◽

Cited By ~ 1

Author(s):

Marcus Sellars ◽

Josephine M. Clayton ◽

Karen M. Detering ◽

Allison Tong ◽

David Power ◽

...

Keyword(s):

Older Adults ◽

Kidney Disease ◽

Decision Analysis ◽

Advance Care Planning ◽

End Of Life Care ◽

Care Planning ◽

Life Care ◽

End Stage Kidney Disease ◽

Advance Care ◽

End Stage

Download Full-text

Engaging patients and family members to design and implement patient-centered kidney disease research

Research Involvement and Engagement ◽

10.1186/s40900-020-00237-y ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Teri Browne ◽

Amy Swoboda ◽

Patti L. Ephraim ◽

Katina Lang-Lindsey ◽

Jamie A. Green ◽

...

Keyword(s):

Kidney Disease ◽

Family Member ◽

Outcomes Research ◽

Family Members ◽

The United States ◽

Transitions Of Care ◽

End Stage Kidney Disease ◽

Patient Centered ◽

Disease Research ◽

End Stage

Plain English summary We need more research projects that partner and engage with patients and family members as team members. Doing this requires that patients and family members set research priorities and fully participate in research teams. Models for this patient and family member engagement as research partners can help increase patient centered outcomes research. In this article, we describe how we have successfully engaged patients with kidney disease and family members as Co-Investigators on a 5-year research project testing a health system intervention to improve kidney disease care. Abstract Background This article describes a method for successful engagement of patients and family members in all stages of a 5-year comparative effectiveness research trial to improve transitions of care for patients from chronic kidney disease to end-stage kidney disease. Methods This project utilized the Patient-Centered Outcomes Research Institute’s conceptual model for engagement with patients and family members. We conducted a qualitative analysis of grant planning meetings to determine patient and family member Co-Investigators’ priorities for research and to include these engagement efforts in the research design. Patient and family member Co-Investigators partnered in writing this paper. Results Patients and family members were successfully engaged in remote and in-person meetings to contribute actively to research planning and implementation stages. Three patient-centered themes emerged from our data related to engagement that informed our research plan: kidney disease treatment decision-making, care transitions from chronic to end-stage kidney disease, and patient-centered outcomes. Conclusions The model we have employed represents a new paradigm for kidney disease research in the United States, with patients and family members engaged as full research partners. As a result, the study tests an intervention that directly responds to their needs, and it prioritizes the collection of outcomes data most relevant to patient and family member Co-Investigators. Trial registration NCT02722382.

Download Full-text

122CLINICIAN ATTITUDES REGARDING THE UTILITY OF FRAILTY TOOLS IN MANAGING OLDER ADULTS WITH END STAGE KIDNEY DISEASE: LITERATURE REVIEW AND SURVEY STUDY

Age and Ageing ◽

10.1093/ageing/afy204.15 ◽

2019 ◽

Vol 48 (Supplement_1) ◽

pp. i32-i35

Author(s):

A P W Kumarasinghe ◽

C Inderjeeth ◽

S Maher ◽

A Chakera ◽

S Dogra ◽

...

Keyword(s):

Older Adults ◽

Kidney Disease ◽

Literature Review ◽

Survey Study ◽

End Stage Kidney Disease ◽

End Stage

Download Full-text

Coping Strategies of Patients with End Stage Kidney Disease on Hemodialysis: A Systematic Review

Nephrology Nursing Journal ◽

10.37526/1526-744x.2021.48.1.31 ◽

2021 ◽

Vol 48 (1) ◽

pp. 31

Author(s):

Tan Woei Ling ◽

Lee Khuan ◽

Anisah Baharom ◽

Mohd Mursyid Arshad

Keyword(s):

Systematic Review ◽

Kidney Disease ◽

Coping Strategies ◽

End Stage Kidney Disease ◽

End Stage

Download Full-text

Patient-Centered Approach for Hypertension Management in End-Stage Kidney Disease: Art or Science?

Seminars in Nephrology ◽

10.1016/j.semnephrol.2018.05.006 ◽

2018 ◽

Vol 38 (4) ◽

pp. 355-368

Author(s):

Elvira O. Gosmanova ◽

Csaba P. Kovesdy

Keyword(s):

Kidney Disease ◽

Hypertension Management ◽

End Stage Kidney Disease ◽

Patient Centered ◽

End Stage

Download Full-text

Local Experience: Battling for CAPD in Pakistan: The Shifa Experience

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd42156 ◽

2021 ◽

Vol 4 (2) ◽

Author(s):

Kiran Khurshid

Keyword(s):

Quality Of Life ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Gradual Increase ◽

End Stage Kidney Disease ◽

Patient Centered ◽

Local Experience ◽

End Stage

Peritoneal Dialysis (PD) is recognized as a patient centered modality for End Stage Kidney Disease worldwide. Compared to In-Centre Hemodialysis, it gives the patients a better quality of life. Rather than urgent start, 2 weeks rest after placement of PD catheter is preferred to avoid leaks. Since I joined Shifa International hospital Islamabad, Pakistan, a gradual increase in CPAD population was seen. We share our experience and discuss the issues faced.

Download Full-text