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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Older patients and dialysis shared decision-making. Insights from an ethnographic discourse analysis of interviews and clinical interactions. PATIENT EDUCATION AND COUNSELING 2024; 122:108124. [PMID: 38232671 DOI: 10.1016/j.pec.2023.108124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/17/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To describe and analyse the perspectives and communication practices of kidney clinicians and older patients (aged 60 +) during collaborative education and decision-making about dialysis. METHODS This qualitative study drew on pluralistic data sources and analytical approaches investigating elicited semi-structured interviews (n = 31) with doctors (n = 8), nurses (n = 8) and patients (n = 15), combined with ethnographic observations, written artefacts and audio-recorded naturally-occurring interactions (n = 23, education sessions n = 4; consultations n = 19) in a tertiary Australian kidney outpatient clinic. Data were analysed for themes and linguistic discourse features. RESULTS Five themes were identified across all data sources: 1) lost opportunity in education; 2) persistent disease knowledge gaps; 3) putting up with dialysis; 4) perceived and real involvement in decision-making and 5) complex role of family as decision-making brokers. CONCLUSION As the first study to complement interviews with evidence from naturally-occurring kidney interactions, this study balances the perspectives of how older patients and their clinicians view chronic kidney disease education, with how decision-making about dialysis is reflected in practice. PRACTICE IMPLICATIONS The study provides suggestions for contextualized, multi-perspectives formal and informal training for improving decision-making about dialysis, spanning from indications to boost communication efficiency, to reducing unexplained jargon, incorporating patient navigators and exploring different dialysis modalities.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
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Jongejan M, de Lange S, Bos WJW, Pieterse AH, Konijn WS, van Buren M, Abrahams AC, van Oevelen M. Choosing conservative care in advanced chronic kidney disease: a scoping review of patients' perspectives. Nephrol Dial Transplant 2024; 39:659-668. [PMID: 37669893 DOI: 10.1093/ndt/gfad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Conservative care (CC) is a viable treatment option for some patients with kidney failure. Choosing between dialysis and CC can be a complex decision in which involvement of patients is desirable. Gaining insight into the experiences and preferences of patients regarding this decision-making process is an important initial step to improve care. We aimed to identify what is known about the perspective of patients regarding decision-making when considering CC. METHODS PubMed, EMBASE and Cochrane databases were systematically searched on 23 February 2023 for qualitative and quantitative studies on patient-reported experiences on decision-making about CC. Data were analysed thematically. RESULTS Twenty articles were included. We identified three major themes: creating awareness about disease and treatment choice, decision support and motivation to choose CC. Patients were often not aware of the option to choose CC. Patients felt supported by their loved ones during the decision-making process, although they perceived they made the final decision to choose CC themselves. Some patients felt pressured by their healthcare professional to choose dialysis. Reported reasons to choose CC were maintaining quality of life, treatment burden of dialysis, cost and the desire not to be a burden to others. In general, patients were satisfied with their decision for CC. CONCLUSIONS By focussing on the perspective of patients, we identified a wide range of patient experiences and preferences regarding the decision-making process. These findings can help to improve the complex decision-making process between dialysis and CC and to provide patient-centred care.
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Affiliation(s)
- Micha Jongejan
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne de Lange
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Wanda S Konijn
- Dutch Kidney Patient Association (NVN), Bussum, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nephrology, Haga Hospital, The Hague, The Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathijs van Oevelen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Ramakrishnan C, Widjaja N, Malhotra C, Finkelstein E, Khan BA, Ozdemir S. Unravelling complex choices: multi-stakeholder perceptions on dialysis withdrawal and end-of-life care in kidney disease. BMC Nephrol 2024; 25:6. [PMID: 38172719 PMCID: PMC10765633 DOI: 10.1186/s12882-023-03434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For patients on dialysis with poor quality of life and prognosis, dialysis withdrawal and subsequent transition to palliative care is recommended. This study aims to understand multi-stakeholder perspectives regarding dialysis withdrawal and identify their information needs and support for decision-making regarding withdrawing from dialysis and end-of-life care. METHODS Participants were recruited through purposive sampling from eight dialysis centers and two public hospitals in Singapore. Semi-structured in-depth interviews were conducted with 10 patients on dialysis, 8 family caregivers, and 16 renal healthcare providers. They were held in-person at dialysis clinics with patients and caregivers, and virtually via video-conferencing with healthcare providers. Interviews were audio-recorded, transcribed, and thematically analyzed. The Ottawa Decision Support Framework's decisional-needs manual was used as a guide for data collection and analysis, with two independent team members coding the data. RESULTS Four themes reflecting perceptions and support for decision-making were identified: a) poor knowledge and fatalistic perceptions; b) inadequate resources and support for decision-making; c) complexity of decision-making, unclear timing, and unpreparedness; and d) internal emotions of decisional conflict and regret. Participants displayed limited awareness of dialysis withdrawal and palliative care, often perceiving dialysis withdrawal as medical abandonment. Patient preferences regarding decision-making ranged from autonomous control to physician or family-delegated choices. Cultural factors contributed to hesitancy and reluctance to discuss end-of-life matters, resulting in a lack of conversations between patients and providers, as well as between patients and their caregivers. CONCLUSIONS Decision-making for dialysis withdrawal is complicated, exacerbated by a lack of awareness and conversations on end-of-life care among patients, caregivers, and providers. These findings emphasize the need for a culturally-sensitive tool that informs and prepares patients and their caregivers to navigate decisions about dialysis withdrawal and the transition to palliative care. Such a tool could bridge information gaps and stimulate meaningful conversations, fostering informed and culturally aligned decisions during this critical juncture of care.
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Affiliation(s)
- Chandrika Ramakrishnan
- Duke-NUS Medical School, Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Singapore, Singapore
- Duke NUS Medical School, Signature Programme in Health Services and Research, Singapore, Singapore
| | - Nathan Widjaja
- Duke-NUS Medical School, Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Singapore, Singapore
- Nanyang Technological University, Singapore, Singapore
| | - Chetna Malhotra
- Duke-NUS Medical School, Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Singapore, Singapore
- Duke NUS Medical School, Signature Programme in Health Services and Research, Singapore, Singapore
| | - Eric Finkelstein
- Duke-NUS Medical School, Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Singapore, Singapore
- Duke NUS Medical School, Signature Programme in Health Services and Research, Singapore, Singapore
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Behram Ali Khan
- Division of Nephrology, National University Health System, Singapore, Singapore
- National Kidney Foundation, Singapore, Singapore
| | - Semra Ozdemir
- Duke-NUS Medical School, Lien Centre for Palliative Care, Programme in Health Services and Systems Research, Singapore, Singapore.
- Duke NUS Medical School, Signature Programme in Health Services and Research, Singapore, Singapore.
- Department of Population Health Sciences, Duke University, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
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Dahm MR, Raine SE, Slade D, Chien LJ, Kennard A, Walters G, Spinks T, Talaulikar G. Shared decision making in chronic kidney disease: a qualitative study of the impact of communication practices on treatment decisions for older patients. BMC Nephrol 2023; 24:383. [PMID: 38129771 PMCID: PMC10734071 DOI: 10.1186/s12882-023-03406-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Effective interpersonal communication is critical for shared decision-making (SDM). Previous SDM communication training in nephrology has lacked context-specific evidence from ethnographic analysis of SDM interactions with older patients considering treatment options of end stage kidney disease (ESKD). This study explores communication strategies in SDM discussions in nephrology, specifically focusing on older patients considering dialysis as kidney replacement therapy (KRT). METHODS We conducted a qualitative study analysing naturally-occurring audio-recorded clinical interactions (n = 12) between Australian kidney doctors, patients aged 60+, and carers. Linguistic ethnography and qualitative socially-oriented functional approaches were used for analysis. RESULTS Two types of communication strategies emerged: (1) Managing and advancing treatment decisions: involving active checking of knowledge, clear explanations of options, and local issue resolution. (2) Pulling back: Deferring or delaying decisions through mixed messaging. Specifically for non-English speaking patients, pulling back was further characterised by communication challenges deferring decision-making including ineffective issue management, and reliance on family as interpreters. Age was not an explicit topic of discussion among participants when it came to making decisions about KRT but was highly relevant to treatment decision-making. Doctors appeared reluctant to broach non-dialysis conservative management, even when it appears clinically appropriate. Conservative care, an alternative to KRT suitable for older patients with co-morbidities, was only explicitly discussed when prompted by patients or carers. CONCLUSIONS The findings highlight the impact of different communication strategies on SDM discussions in nephrology. This study calls for linguistic-informed contextualised communication training and provides foundational evidence for nephrology-specific communication skills training in SDM for KRT among older patients. There is urgent need for doctors to become confident and competent in discussing non-dialysis conservative management. Further international research should explore naturally-occurring SDM interactions in nephrology with other vulnerable groups to enhance evidence and training integration.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia.
| | - Suzanne Eggins Raine
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Laura J Chien
- Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT, 2601, Australia
| | - Alice Kennard
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Giles Walters
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Tony Spinks
- Canberra Hospital Renal Service, Canberra, Australia
| | - Girish Talaulikar
- Canberra Hospital Renal Service, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
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Liu CK, Taffel L, Russell M, Wong SPY, Russell H, Vig EK. Decision-making about dialysis: Beyond just dialysis or death. J Am Geriatr Soc 2023; 71:1378-1385. [PMID: 36790053 PMCID: PMC10175117 DOI: 10.1111/jgs.18256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 02/16/2023]
Abstract
Nearly half of the persons receiving dialysis in the United States are aged 65 years or older. Kidney failure occurs most frequently in older adults, and typically triggers a discussion regarding dialysis treatment. In this Special Article, we describe the journey of Mr. Howard Russell, an older adult who experienced kidney failure and underwent dialysis. Using the experience of Mr. Russell, we illustrate the complexity of dialysis decision-making, including how disease trajectory and health policy can potentially impede older adults from achieving "what matters." Our intent is to provide guidance regarding these barriers and support to clinicians who are sharing similar journeys with older adults making decisions about dialysis. Based on Mr. Russell's journey, we suggest that when discussing dialysis with an older adult, four points be considered: (1) recognize if dialysis is needed long-term; (2) understand what matters for the older adult; (3) sync the treatment plan when what matters changes; and (4) set up with resources for kidney failure, which is limited but evolving.
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Affiliation(s)
- Christine Kee Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University, School of Medicine, Stanford, California, USA
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Leah Taffel
- Section of Geriatrics, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Matthew Russell
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan P Y Wong
- Division of Nephrology, VA Puget Sound Health Care System, Seattle, Washington, USA
- Division of Nephrology, Kidney Research Institute, University of Washington, Seattle, Washington, USA
| | | | - Elizabeth K Vig
- Geriatrics and Extended Care, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
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6
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Saji A, Oishi A, Harding R. Self-perceived Burden for People With Life-threatening Illness: A Qualitative Systematic Review. J Pain Symptom Manage 2023; 65:e207-e217. [PMID: 36368570 DOI: 10.1016/j.jpainsymman.2022.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
CONTEXT The perception of being a burden to others is a significant concern for people with life-threatening illness. It is unclear what underpins the concept of "self-perceived burden". OBJECTIVES To appraise and integrate primary evidence underpinning the concept of self-perceived burden (SPB) with respect to their informal caregivers among adult patients with life-threatening illness. METHODS This is a systematic review and a thematic synthesis of qualitative primary data. MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science were searched in September 2021, supplemented by hand searching of textbooks and web search engines, peer-review journals, and contact with experts. Qualitative studies were included if they provided primary data of adult patients' (with life-limiting illness) SPB toward their informal caregivers. Studies were appraised using the Critical Appraisal Skills Programme checklist. RESULTS Nine studies were included, reporting on 219 patients who mostly had advanced life-threatening illness and needed physical assistance for daily activities. SPB is a highly subjective perception contrasting self and/or informal caregivers in the past, present, and future. Patients develop SPB feeling uncertain about caregivers' perceptions and increasing future burden. SPB interacts with other factors of surrounding complex balances (such as care needs, reality, and identity) which would change over time, and patients' reactions to SPB at the sacrifice of their wishes may conversely increase the total suffering. CONCLUSION SPB is not a static perception but a fluctuating and complex 'process' based on uncertainty. More diverse understandings and following interventions to achieve a better balance of care should be sought.
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Affiliation(s)
- Asako Saji
- Yokohama-shi Kotobuki-cho Kenko Fukushi Koryu Center Clinic (A.S.), Kanagawa, Japan.
| | - Ai Oishi
- Kamakura Family Clinic (A.O.), Kanagawa, Japan; Department of Health Data Science (A.O.), Yokohama City University, Kanagawa, Japan
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute (R.H.), King's College London, London, United Kingdom
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Frazier R, Levine S, Porteny T, Tighiouart H, Wong JB, Isakova T, Koch-Weser S, Gordon EJ, Weiner DE, Ladin K. Shared Decision Making Among Older Adults With Advanced CKD. Am J Kidney Dis 2022; 80:599-609. [PMID: 35351579 DOI: 10.1053/j.ajkd.2022.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Older adults with advanced chronic kidney disease (CKD) face difficult decisions about dialysis initiation. Although shared decision making (SDM) can help align patient preferences and values with treatment options, the extent to which older patients with CKD experience SDM remains unknown. STUDY DESIGN A cross-sectional analysis of patient surveys examining decisional readiness, treatment options education, care partner support, and SDM. SETTING & PARTICIPANTS Adults aged 70 years or older from Boston, Chicago, San Diego, or Portland (Maine) with nondialysis advanced CKD. PREDICTORS Decisional readiness factors, treatment options education, and care partner support. OUTCOMES Primary: SDM measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) instrument, with higher scores reflecting greater SDM. Exploratory: Factors associated with SDM. ANALYTICAL APPROACH We used multivariable linear regression models to examine the associations between SDM and predictors, controlling for demographic and health factors. RESULTS Among 350 participants, mean age was 78 ± 6 years, 58% were male, 13% identified as Black, and 48% had diabetes. Mean SDM-Q-9 score was 52 ± 28. SDM item agreement ranged from 41% of participants agreeing that "my doctor and I selected a treatment option together" to 73% agreeing that "my doctor told me that there are different options for treating my medical condition." In multivariable analysis adjusted for demographic characteristics, lower estimated glomerular filtration rate, and diabetes, being "well informed" and "very well informed" about kidney treatment options, having higher decisional certainty, and attendance at a kidney treatment options class were independently associated with higher SDM-Q-9 scores. LIMITATIONS The cross-sectional study design limits the ability to make temporal associations between SDM and the predictors. CONCLUSIONS Many older patients with CKD do not experience SDM when making dialysis decisions, emphasizing the need for greater access to and delivery of education for individuals with advanced CKD.
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Affiliation(s)
- Rebecca Frazier
- Division of Nephrology and Hypertension, Department of Medicine, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois; Jesse Brown Veterans Administration Medical Center, Chicago, Illinois.
| | - Sarah Levine
- William B. Schwartz MD Division of Nephrology, Tufts University School of Medicine, Boston, Massachusetts
| | - Thalia Porteny
- Research on Ethics, Aging, and Community Health (REACH Lab) and Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Tufts University School of Medicine, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois
| | - Susan Koch-Weser
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Elisa J Gordon
- Department of Surgery-Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel E Weiner
- William B. Schwartz MD Division of Nephrology, Tufts University School of Medicine, Boston, Massachusetts
| | - Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab) and Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
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Pergolizzi D, Crespo I. The past and future of uncertainty in advanced illness: a systematic scoping review of underlying cognitive processes. ANXIETY, STRESS, & COPING 2022; 36:415-433. [DOI: 10.1080/10615806.2022.2134566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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9
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Chan K, Wong FKY, Tam SL, Kwok CP, Fung YP, Wong PN. Effectiveness of a brief hope intervention for chronic kidney disease patients on the decisional conflict and quality of life: a pilot randomized controlled trial. BMC Nephrol 2022; 23:209. [PMID: 35701732 PMCID: PMC9195369 DOI: 10.1186/s12882-022-02830-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background Stage 5 chronic kidney disease (CKD) patients often experience decisional conflict when faced with the selection between the initiation of dialysis and conservative care. The study examined the effects of a brief hope intervention (BHI) on the levels of hope, decisional conflict and the quality of life for stage 5 CKD patients. Methods This is a single-blinded, randomized controlled trial (ClinicalTrials.gov identifier: NCT03378700). Eligible patients were recruited from the outpatient department renal clinic of a regional hospital. They were randomly assigned to either the intervention or the control group (intervention: n = 35; control: n = 37). All participants underwent a customized pre-dialysis education class, while the intervention group received also BHI. Data were collected prior to the intervention, immediately afterwards, and one month following the intervention. The Generalized Estimating Equation was used to measure the effects in the level of hope, decisional conflict scores (DCS) and Kidney Disease Quality of life (KDQOL-36) scores. Estimated marginal means and standard errors with 95% confidence intervals of these scores were also reported to examine the within group and between group changes. Results An increase of the hope score was found from time 1 (29.7, 1.64) to time 3 (34.4, 1.27) in the intervention group. The intervention had a significant effect on the KDQOL-36 sub-scores Mental Component Summary (MCS) (Wald χ2 = 6.763, P = 0.009) and effects of kidney disease (Wald χ2 = 3.617, P = 0.004). There was a reduction in decisional conflict in both arms on the DCS total score (Wald χ2 = 7.885, P = 0.005), but the reduction was significantly greater in the control group (effect size 0.64). Conclusions The BHI appeared to increase the level of hope within the intervention arm. Nonetheless, differences across the intervention and control arms were not significant. The KDQOL-36 sub-scores on MCS and Effects of kidney disease were found to have increased and be higher in the intervention group. The DCS total score also showed that hope was associated with reducing decisional conflict. Trial Registration ClinicalTrials.gov Protocol Registration, NCT03378700. Registered July 12 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02830-7.
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Affiliation(s)
- Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China.
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, People's Republic of China
| | - Suet Lai Tam
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ching Ping Kwok
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
| | - Yuen Ping Fung
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ping Nam Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, People's Republic of China
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10
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Wong SP, Oestreich T, Chandler B, Curtis JR. Using Human-Centered Design Principles to Create a Decision Aid on Conservative Kidney Management for Advanced Kidney Disease. KIDNEY360 2022; 3:1242-1252. [PMID: 35919540 PMCID: PMC9337892 DOI: 10.34067/kid.0000392022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/04/2022] [Indexed: 01/11/2023]
Abstract
Background Most patients are unaware of approaches to treating advanced chronic kidney disease (CKD) other than dialysis. Methods We developed a dedicated decision aid on conservative kidney management using human-centered design principles in three phases: (1) discovery: engagement of informants to understand their needs and preferences; (2) design: multiple rapid cycles of ideation, prototyping, and testing of a decision aid with a small group of informants; and (3) implementation: testing the decision aid in real-world settings with attention to how the decision aid can be further refined. Informants included a national patient advisory committee on kidney diseases, 50 patients with stage 4 or 5 CKD and 35 of their family members, and 16 clinicians recruited from the greater Seattle area between June 2019 and September 2021. Results Findings from the discovery phase informed an initial prototype of the decision aid, which included five sections: a description of kidney disease and its signs and symptoms, an overview of conservative kidney management and the kinds of supports provided, self-reflection exercises to elicit patients' values and goals, the pros and cons of conservative kidney management, and the option of changing one's mind about conservative kidney management. The prototype underwent several rounds of iteration during its design phase, which resulted in the addition of an introductory section describing the intended audience and more detailed information in other sections. Findings from its implementation phase led to the addition of examples of common questions that patients and family members had about conservative kidney management and a final section on other related educational resources. Conclusions Human-centered design principles supported a systematic and collaborative approach between researchers, patients, family members, and clinicians for developing a decision aid on conservative kidney management.
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Affiliation(s)
- Susan P.Y. Wong
- VA Puget Sound Health Care System, Division of Nephrology, University of Washington, Seattle, Washington,University of Washington, School of Medicine, Division of Nephrology, Seattle, Washington
| | - Taryn Oestreich
- University of Washington, School of Medicine, Division of Nephrology, Seattle, Washington
| | - Bridgett Chandler
- University of Washington, School of Medicine, Division of Nephrology, Seattle, Washington
| | - J. Randall Curtis
- University of Washington, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington
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11
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Chen JHC, Lim WH, Howson P. Changing landscape of dialysis withdrawal in patients with kidney failure: Implications for clinical practice. Nephrology (Carlton) 2022; 27:551-565. [PMID: 35201646 PMCID: PMC9315017 DOI: 10.1111/nep.14032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/09/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
Dialysis withdrawal has become an accepted treatment option for patients with kidney failure and is one of the leading causes of death in patients receiving dialysis in high-income countries. Despite its increasing acceptance, dialysis withdrawal currently lacks a clear, consistent definition. The processes and outcomes of dialysis withdrawal have wide temporal and geographical variability, attributed to dialysis patient selection, influence from cultural, religious and spiritual beliefs, and availability of kidney replacement therapy and conservative kidney management. As a complex, evolving process, dialysis withdrawal poses an enormous challenge for clinicians and healthcare teams with various limitations precluding a peaceful and smooth transition between active dialysis and end-of-life care. In this review, we examine the current definitions of dialysis withdrawal, the temporal and geographical patterns of dialysis withdrawal, international barriers in the decision-making process (including dialysis withdrawal during the COVID-19 pandemic), and gaps in the current dialysis withdrawal recommendations for clinical consideration and future studies.
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Affiliation(s)
- Jenny H C Chen
- Faculty of Medicine, University of Wollongong, Wollongong, Australia.,Wollongong Hospital, Wollongong, Australia
| | - Wai H Lim
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia.,Faculty of Medicine, University of Western Australia, Perth, Australia
| | - Prue Howson
- Department of Nephrology, Sir Charles Gairdner Hospital, Perth, Australia
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12
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Fouché N, Bidii D, De Swardt C. An exploration of nephrology nurses’ experiences of caring for dying patients with end Stage Kidney Disease (ESKD) following withdrawal of dialysis – A South African perspective. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Carswell C, Yaqoob M, Gilbert P, Kuan Y, Laurente G, McGuigan K, McKeaveney C, McVeigh C, Reid J, Rej S, Walsh I, Noble H. Exploration of Caregiver Experiences of Conservatively Managed End-Stage Kidney Disease to Inform Development of a Psychosocial Intervention: The ACORN Study Protocol. Healthcare (Basel) 2021; 9:healthcare9121731. [PMID: 34946457 PMCID: PMC8701309 DOI: 10.3390/healthcare9121731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background: End-stage kidney disease (ESKD) is an overwhelming illness that impacts not just patients, but also their informal carers. Patients who opt for conservative management rather than dialysis experience difficult symptoms and the psychosocial consequences of their condition. Informal carers of patients who choose conservative management can also experience high levels of psychosocial burden, yet there is little guidance on how best to support informal carers, and no evidence on psychosocial interventions to address unmet needs. Aim: The aim of this study is to explore the experiences and unmet needs of informal carers of patients with ESKD receiving conservative management in order to inform the development of a psychosocial intervention. Methods: This qualitative study will consist of three stages: (I) semi-structured interviews with informal carers in England and Northern Ireland, (II) focus groups with healthcare professionals and informal carers, and (III) national workshops to refine the components of a psychosocial intervention. Discussion: Informal carers of patients with ESKD who are receiving conservative management experience a high psychosocial burden, but there is limited evidence on how best to provide support, particularly as the patient nears the end of life. To our knowledge this study will be the first to address this gap by exploring the experiences and unmet needs of informal carers, with the aim of informing the development of a psychosocial intervention to support the health and wellbeing of informal carers.
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
- Department of Health Sciences, University of York, York YO10 5DD, UK
- Correspondence:
| | | | - Patricia Gilbert
- Northern Ireland Kidney Patient Association, Belfast BT9 7AB, UK;
| | - Ying Kuan
- Western Health and Social Care Trust, Londonderry BT47 6SB, UK;
| | - Gladys Laurente
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
- Barts Health NHS Trust, London E1 1BB, UK;
| | - Karen McGuigan
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
| | - Soham Rej
- Department of Psychiatry, Jewish General Hospital/Lady Davis Institute, McGill University, Montréal, QC H3A 0G4, Canada;
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT7 1NN, UK; (G.L.); (K.M.); (C.M.); (C.M.); (J.R.); (H.N.)
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14
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Goh ZZS, Chia JMX, Seow TYY, Choo JCJ, Foo M, Seow PS, Griva K. Treatment-related decisional conflict in pre-dialysis chronic kidney disease patients in Singapore: Prevalence and determinants. Br J Health Psychol 2021; 27:844-860. [PMID: 34865298 DOI: 10.1111/bjhp.12577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In advanced chronic kidney disease (CKD), patients face complex decisions related to renal replacement modality that can cause decisional conflict and delay. This study aimed to evaluate the prevalence of severe decisional conflict across decision types and to identify the psychosocial and clinical factors associated with decisional conflict in this population. DESIGN Observational cross-sectional study. METHODS Patients with CKD in renal care were recruited. The Decisional Conflict Scale (DCS), Functional, Communicative, and Critical Health Literacy (FCCHL), Health Literacy Questionnaire (HLQ), Hospital Anxiety and Depression Scale (HADS), Brief Illness Perception Questionnaire (BIPQ), and the Kidney-disease Quality of Life (KDQOL) questionnaires were used. Clinical data were obtained from medical records. Bivariate and multivariable logistic regression models were used to identify predictors of severe decisional conflict (DCS score ≥ 37.5). RESULTS Participants (N = 190; response rate = 56.7%; mean age = 62.8 ± 10.8) reported moderate levels of decisional conflict (29.7 ± 14.5). The overall prevalence of severe decisional conflict was 27.5% (n = 46) with no significant differences across decision types (dialysis, modality, access). Ethnicity (Chinese), marital status (married), BIPQ treatment control, coherence, KDQOL staff encouragement, and all health literacy domains, except functional health literacy, were significant predictors of decisional conflict in the unadjusted models. In the multivariable model, only the health literacy domains of FCCHL Communicative, and HLQ Active Engagement remained significant. CONCLUSION Even after pre-dialysis education, many CKD patients in this study still report severe decisional conflict, with rates remaining substantial across decision junctures. The associations of decisional conflict and health literacy skills related to communication and engagement with healthcare providers indicate that more collaborative and patient-centric pre-dialysis programs may support patient activation and resolve decisional conflict.
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Affiliation(s)
- Zack Zhong Sheng Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Jace Ming Xuan Chia
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | | | | | | | | | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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15
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Abstract
BACKGROUND Self-perceived burden (SPB) causes stress and negatively impacts the quality of life and mental health of patients. It is important to identify effective coping methods to reduce SPB when supporting advanced cancer patients. OBJECTIVE To qualitatively elucidate advanced cancer patients' strategies for coping with SPB. METHODS Eleven participants with advanced cancer were recruited from 2 palliative care units. The data were collected through semistructured interviews and analyzed by content analysis. RESULTS One of the coping strategies that advanced cancer patients used to reduce their SPB was "making individual efforts to deal with their own circumstances." This category included subcategories: "making proactive action," "expressing their gratitude verbally," "suppressing their feelings," "searching for positive meanings," and "avoiding thinking about the burden on their families." Another coping strategy used was "exploring the solutions with their family," which consisted of one subcategory and indicated an open dialogue between patients and their families to reach acceptable and mutual decisions about patient care. CONCLUSION Nurses should not only support patients' efforts to tackle the situation by themselves, but also help the family as a whole to tackle problems together. By facilitating meaningful dialogue between family members, patients' feelings of SPB can be alleviated. IMPLICATIONS FOR PRACTICE Nurses should facilitate dialogue between patients and their family members in order to help them discover solutions to reduce their SPB and to find positive meanings in the caregiving-receiving situation.
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16
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Chan K, Wong F, Tam SL, Kwok CP, Fung YP, Wong PN. The effects of a brief hope intervention on decision-making in chronic kidney disease patients: A study protocol for a randomized controlled trial. J Adv Nurs 2020; 76:3631-3640. [PMID: 33038022 DOI: 10.1111/jan.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/15/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
AIMS This study describes the study protocol of a manualized brief hope intervention that is based on the theoretical proposition - hope theory. BACKGROUND Patients with stage 5 chronic kidney disease often had decisional regret when facing the tension of treatment alternatives between dialysis initiation and palliative care. Hope has been found to account for therapeutic changes in clients with depressive symptoms, heightens positive expectations, and striving to accomplish chosen goals. Nevertheless, little is known about the effect of hope on decisional conflict and its influences to the quality of life in these chronic kidney disease patients. DESIGN This study is a single-blinded, randomized controlled trial. METHODS Participants will be recruited from a regional hospital (approved in April 2018). They will be randomly assigned in equal numbers to either the brief hope intervention or the control arm on completion of the baseline assessment on the possible need of dialysis initiation. Participants in the intervention group will receive the pre-dialysis education and a 4-week Brief Hope Intervention [consisting of four sessions at weekly intervals (two face-to-face sessions and two telephone follow-up sessions in between)], while those allocated to the control arm will receive the renal education and social chats. Outcome measures will be carried out prior to the intervention (baseline), immediately, and 1 month after the intervention. These consist of the hope level, decisional conflict, and quality of life. Healthcare resources use data will be reported. IMPACT The study results have the potential to add scientific evidence to the research-tested programme when developing renal services integral to multimodal care management to optimize decision-making and attain better health outcomes.
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Affiliation(s)
- Kitty Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Frances Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Suet Lai Tam
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Ching Ping Kwok
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Yuen Ping Fung
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Ping Nam Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
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17
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Sarfo-Walters C, Boateng EA. Perceptions of patients with end-stage kidney disease (ESKD) and their informal caregivers on palliative care as a treatment option: a qualitative study. BMC Palliat Care 2020; 19:133. [PMID: 32819349 PMCID: PMC7441556 DOI: 10.1186/s12904-020-00640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background Palliative care is increasingly becoming an accepted treatment choice for many individuals diagnosed with end-stage kidney disease (ESKD). Yet, its utilisation is non-existent in many lower- and middle-income countries (LMICs). This study explored the perceptions of individuals with ESKD and their informal caregivers on palliative care as a treatment option for the disease in Ghana. Methods This was a phenomenological study, with an in-depth analysis of data collected from nine individuals with ESKD and six informal caregivers through individual, face-to-face semi-structured interviews. The study was conducted in two renal centres within the Kumasi metropolis, Ghana among individuals with ESKD seeking care from both renal centres and their informal caregivers. Results Three main themes were derived from this study – motivation for initiating haemodialysis, facing realities of haemodialysis, and considering palliative care. Participants felt that haemodialysis (HD) was not meeting their health expectations and demonstrated a general willingness to utilise palliative care if it would reduce suffering. Conclusions This study has shown that individuals with ESKD or their informal caregivers would consider palliative care services, if available. It paves the way for discussions about palliative care for ESKD to begin across renal centres within Ghana and other similar settings. Exploring perspectives of clinicians in such settings could inform strategies on how to implement palliative care for ESKD management in such settings.
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Affiliation(s)
| | - Edward Appiah Boateng
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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18
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Abstract
Abstract. We examined the negative outcomes, particularly social costs that result when a person harms their group by performing poorly, and whether self-compassion could buffer against these negative outcomes. In Studies 1 and 2, participants performed poorly and harmed their group or performed equal to their group. Harmful poor-performing participants felt more burdensome, experienced more negative affect, felt more ostracized, anticipated more exclusion, and felt lowered self-esteem than equal-performing participants. Studies 3 and 4 disentangled poor performance from harming a group. Poor-performing participants either harmed the group or caused no harm. Harmful poor-performing participants felt more burdensome and anticipated more exclusion, indicating the additional social consequences of a harmful poor performance over a non-harmful performance. Across studies, trait self-compassion was associated with reduced negative effects.
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Affiliation(s)
- James H. Wirth
- Department of Psychology, Ohio State University at Newark, OH, USA
| | - Ashley Batts Allen
- Department of Psychology, University of North Carolina at Pembroke, NC, USA
| | - Emily M. Zitek
- School of Industrial and Labor Relations, Cornell University, Ithaca, NY, USA
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19
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Sowerbutts AM, Lal S, Sremanakova J, Clamp AR, Jayson GC, Teubner A, Hardy L, Todd C, Raftery AM, Sutton E, Morgan RD, Vickers AJ, Burden S. Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers. BMC Palliat Care 2019; 18:120. [PMID: 31884962 PMCID: PMC6936090 DOI: 10.1186/s12904-019-0507-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
Background Malnutrition is a problem in advanced cancer, particularly ovarian cancer where malignant bowel obstruction (MBO) is a frequent complication. Parenteral nutrition is the only way these patients can received adequate nutrition and is a principal indication for palliative home parenteral nutrition (HPN). Giving HPN is contentious as it may increase the burden on patients. This study investigates patients’ and family caregivers’ experiences of HPN, alongside nutritional status and survival in patients with ovarian cancer and MBO. Methods This mixed methods study collected data on participant characteristics, clinical details and body composition using computed tomography (CT) combined with longitudinal in-depth interviews underpinned by phenomenological principles. The cohort comprised 38 women with ovarian cancer and inoperable MBO admitted (10/2016 to 12/ 2017) to a tertiary referral hospital. Longitudinal interviews (n = 57) were carried out with 20 women considered for HPN and 13 of their family caregivers. Results Of the 38 women, 32 received parenteral nutrition (PN) in hospital and 17 were discharged on HPN. Nutritional status was poor with 31 of 33 women who had a CT scan having low muscle mass, although 10 were obese. Median overall survival from admission with MBO for all 38 women was 70 days (range 8–506) and for those 17 on HPN was 156 days (range 46–506). Women experienced HPN as one facet of their illness, but viewed it as a “lifeline” that allowed them to live outside hospital. Nevertheless, HPN treatment came with losses including erosion of normality through an impact on activities of daily living and dealing with the bureaucracy surrounding the process. Family caregivers coped but were often left in an emotionally vulnerable state. Conclusions Women and family caregivers reported that the inconvenience and disruption caused by HPN was worth the extended time they had at home.
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Affiliation(s)
- Anne Marie Sowerbutts
- Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK. .,School of Health Sciences, University of Manchester, RM5.328 Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK.
| | - Simon Lal
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - Jana Sremanakova
- Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Gordon C Jayson
- Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | | | - Lisa Hardy
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Todd
- Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Eileen Sutton
- Department of Social Medicine, University of Bristol, Bristol, UK
| | | | | | - Sorrel Burden
- Faculty of Biology, Medicine and Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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20
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Wachterman MW, Leveille T, Keating NL, Simon SR, Waikar SS, Bokhour B. Nephrologists' emotional burden regarding decision-making about dialysis initiation in older adults: a qualitative study. BMC Nephrol 2019; 20:385. [PMID: 31651262 PMCID: PMC6814056 DOI: 10.1186/s12882-019-1565-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 09/26/2019] [Indexed: 01/22/2023] Open
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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Affiliation(s)
- Melissa W. Wachterman
- Section of General Internal Medicine, Veterans Affairs Boston Healthcare System, 150 South Huntington Ave., Bldg. 9, Boston, MA 02130 USA
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | | | - Nancy L. Keating
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Steven R. Simon
- Section of General Internal Medicine, Veterans Affairs Boston Healthcare System, 150 South Huntington Ave., Bldg. 9, Boston, MA 02130 USA
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Sushrut S. Waikar
- Harvard Medical School, Boston, MA USA
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Barbara Bokhour
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA USA
- Center for Healthcare Organization and Implementation of Research, Edith Nourse Rogers Memorial VA Healthcare System, Bedford, MA USA
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21
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Older patients' experiences with a shared decision-making process on choosing dialysis or conservative care for advanced chronic kidney disease: a survey study. BMC Nephrol 2019; 20:264. [PMID: 31311511 PMCID: PMC6635995 DOI: 10.1186/s12882-019-1423-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background Many older patients approaching end-stage kidney disease have to decide whether to go for dialysis or non-dialytic conservative care (CC). Shared decision-making is recommended to align the treatment plan with the patient’s preferences and values. Little is known about older patients’ experiences with shared decision-making on dialysis or CC. Methods We performed a survey study, in collaboration with the Dutch Kidney Patients Association, in 99 patients aged ≥70 years who had chosen dialysis (n = 75) or CC (n = 24) after a shared decision-making process involving an experienced multidisciplinary team. Results Patients stated to be overall satisfied with the shared decision-making process (% with score 6–10 on 11-point Likert scale, dialysis versus CC: 93% vs. 91%, P = 0.06), and treatment decision (87% vs. 91%, P = 0.03). However, patients also reported negative experiences, especially those who had chosen dialysis. Such negative experiences were related to the timing, informing, and level of decision-making being shared. More patients who selected dialysis indicated to have felt forced to make a decision, mostly due to the circumstances, such as their deteriorating health or kidney function, or by their nephrologist (31% vs. 5%, P = 0.01). Also, patients who selected dialysis mentioned a perceived lack of choice as most common reason for choosing dialysis, and 55% considered their own opinion as most important rather than their nephrologists’ or relatives’ opinion compared to 90% of the patients who had chosen CC (P = 0.02). A subset of patients who had chosen dialysis still doubted their treatment decision compared to no patient who had chosen CC (17% vs. 0%, P = 0.03). Conclusions Older patients reported contrasting experiences with shared decision-making on dialysis or CC. Despite high overall satisfaction, the underlying negative experiences illustrate important but modifiable barriers to an optimal shared decision-making process. Electronic supplementary material The online version of this article (10.1186/s12882-019-1423-x) contains supplementary material, which is available to authorized users.
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Axelsson L, Benzein E, Lindberg J, Persson C. Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives. Nurs Ethics 2019; 27:419-432. [PMID: 31185802 DOI: 10.1177/0969733019848050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. AIM The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. RESEARCH DESIGN AND PARTICIPANTS A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. ETHICAL CONSIDERATIONS Ethical approval was obtained (Dnr 2014/304-31). FINDINGS AND DISCUSSION Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. CONCLUSION There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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Affiliation(s)
| | | | - Jenny Lindberg
- Lund University, Sweden; Skåne University Hospital, Sweden
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23
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Murphy E, Germain MJ, Murtagh F. Palliative Nephrology: Time for New Insights. Am J Kidney Dis 2019; 70:593-595. [PMID: 29055351 DOI: 10.1053/j.ajkd.2017.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Emma Murphy
- University of Southampton and University Hospital Southampton, Southampton, United Kingdom.
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24
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Simon J, Murray A, Raffin S. Facilitated Advance Care Planning: What is the Patient Experience? J Palliat Care 2019. [DOI: 10.1177/082585970802400405] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jessica Simon
- Division of Palliative Care, University of Calgary, Calgary
| | - Alison Murray
- Division of Palliative Care, University of Calgary, Calgary
| | - Shelley Raffin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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25
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Selman LE, Bristowe K, Higginson IJ, Murtagh FEM. The views and experiences of older people with conservatively managed renal failure: a qualitative study of communication, information and decision-making. BMC Nephrol 2019; 20:38. [PMID: 30717686 PMCID: PMC6360769 DOI: 10.1186/s12882-019-1230-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/24/2019] [Indexed: 11/17/2022] Open
Abstract
Background Older people with advanced kidney disease require information and support from clinicians when deciding whether to have dialysis or conservative (non-dialysis) care. There is evidence that communication practices, information provision and treatment rates vary widely across renal units. However, experiences of communicating with clinicians among patients receiving conservative care are poorly understood. This evidence is essential to ensure support is patient-centred and equitable. Our aim was to explore views and experiences of communication, information provision and treatment decision-making among older patients receiving conservative care. Methods In-depth qualitative interviews were conducted with patients with stage 5 chronic kidney disease from three UK renal units. Purposive sampling captured variation in age, co-morbidity and functional status. Interviews were analysed thematically. Results 20 patients were interviewed (11 were men; median age 82 (range 69–95)). Participants described positive experiences of communicating with clinicians and receiving information, but also negative experiences involving insensitivity, rushing or ambiguity. Participants reported clinicians omitting/avoiding conversations regarding diagnosis and prognosis, and described what helped and hindered good communication and support. They wanted information about their treatment options and illness, but expressed ambivalence about knowing details of disease progression. Clinicians’ views and recommendations regarding treatment influenced patients’ decision-making. Conclusions Older patients report variable quality in communication with clinicians and gaps in the information received. Uncertainty about the disease trajectory and patients’ ambivalence regarding information makes communication particularly challenging for clinicians. Tailoring information to patient preferences and conveying it clearly and sensitively is critical. Renal clinicians require support and training to ensure decision-making support for older patients is patient-centred. Future research should examine how clinicians’ communication practices influence treatment decision-making.
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Affiliation(s)
- Lucy Ellen Selman
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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Qazi HA, Chen H, Zhu M. Factors influencing dialysis withdrawal: a scoping review. BMC Nephrol 2018; 19:96. [PMID: 29699499 PMCID: PMC5921369 DOI: 10.1186/s12882-018-0894-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/11/2018] [Indexed: 11/15/2022] Open
Abstract
Background Research on factors associated with dialysis withdrawal is scarce. This study examined the predictors that might influence rate of dialysis withdrawal. Existing literature is summarized, analyzed and synthesized to identify gaps in the literature with regard to the factors associated with dialysis withdrawal. Methods This scoping review used a systematic search to synthesize research findings related to dialysis withdrawal and identified gaps in the literature. The search strategy was developed and applied using PubMed, EMBASE and CINHAL databases. The selection criteria included articles written in English and published between 1997 and 2016 that examined dialysis withdrawal and associated factors in patients with any modality of renal dialysis.. Case reports and studies only including renal transplant patients were excluded. Fifteen articles were selected in accordance with these selection criteria. Results The literature review revealed a scarcity of research on dialysis withdrawal and associated factors. Furthermore, the study findings were inconsistent and inconclusive. Authors have defined dialysis withdrawal in terms of dialysis discontinuation, withholding, death, withdrawal, treatment refusal/cessation, or technique failure. Authors have selected homogeneous patient population on either hemodialysis (HD) or peritoneal dialysis (PD) patients, thus making comparisons of studies and generalization of findings difficult. Conclusion Future studies should explore the influence of both HD and PD on patient-elected dialysis withdrawal using a large a priori calculated sample size. Electronic supplementary material The online version of this article (10.1186/s12882-018-0894-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hammad Ali Qazi
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada.
| | - Helen Chen
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Meng Zhu
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Mesa-Melgarejo L, Carrillo-Algarra AJ, Castiblanco RA, Reina LM, Ávila TM. Terapias de sustitución de la función Renal: Metaestudio y síntesis de evidencias cualitativas. AQUICHAN 2017. [DOI: 10.5294/aqui.2017.17.3.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
El objetivo del presente estudio fue sintetizar en términos de evidencias cualitativas o evidencias Q hallazgos derivados de estudios cualitativos frente al tema de las terapias de sustitución de la función renal (TSFR). Método: metaestudio cualitativo desarrollado en cuatro momentos. Resultados: se integraron 75 estudios. De los cuales, 52 exploraban experiencias relacionadas con hemodiálisis (HD), 10 de diálisis peritoneal (DP), 6 trasplante, 6 DP y HD al mismo tiempo y 1 estudio exploró las 3 TSFR. Los estudios incluidos describen y representan el fenómeno de vivir en una condición de cronicidad y estar sometido a una TSFR de manera muy semejante, que se agruparon en patrones comunes del fenómeno, estos son descritos en tres grandes temáticas: la metamorfosis de la vida; dolores diversos y la terapia invade la vida. Conclusión: los resultados dan cuenta de la estrecha interrelación de las dimensiones humanas, por esto el fenómeno de vivir en una TSFR genera una transfiguración el “Ser”, como totalidad, pues no es posible desligar una dimensión de otra, de allí la importancia de pensar la atención de las necesidades en perspectiva relacional y no jerarquizada.
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Jones DJ, Harvey K, Harris JP, Butler LT, Vaux EC. Understanding the impact of haemodialysis on UK National Health Service patients' well-being: A qualitative investigation. J Clin Nurs 2017; 27:193-204. [PMID: 28498615 PMCID: PMC6853155 DOI: 10.1111/jocn.13871] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/29/2022]
Abstract
Aims and objectives While haemodialysis is an effective treatment for end‐stage renal disease, the requirements and restrictions it imposes on patients can be onerous. The aim of this study was to obtain UK National Health Service patients’ perspectives on the challenges arising from haemodialysis with the intention of identifying potential improvements. Background Depression rates are particularly high in those with end‐stage renal disease; however, there is limited insight into the range of stressors associated with haemodialysis treatment within the National Health Service contributing to such high rates, particularly those of a cognitive or psychological nature. Design A qualitative approach was used to obtain rich, patient‐focused data; one‐to‐one semi‐structured interviews were conducted with twenty end‐stage renal disease at a UK National Health Service centre. Methods Patients were interviewed during a typical haemodialysis session. Thematic analysis was used to systematically interpret the data. Codes were created in an inductive and cyclical process using a constant comparative approach. Results Three themes emerged from the data: (i) fluctuations in cognitive/physical well‐being across the haemodialysis cycle, (ii) restrictions arising from the haemodialysis treatment schedule, (iii) emotional impact of haemodialysis on the self and others. The findings are limited to predominantly white, older patients (median = 74 years) within a National Health Service setting. Conclusions Several of the experiences reported by patients as challenging and distressing have so far been overlooked in the literature. A holistic‐based approach to treatment, acknowledging all aspects of a patient's well‐being, is essential if optimal quality of life is to be achieved by healthcare providers. Relevance to clinical practice The findings can be used to inform future interventions and guidelines aimed at improving patients’ treatment adherence and outcomes, for example, improved reliable access to mental health specialists.
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Affiliation(s)
- Daniel Jw Jones
- School of Psychology, University of Reading Malaysia, Nusajaya, Johor, Malaysia
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - John P Harris
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Laurie T Butler
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Emma C Vaux
- Department of Renal Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK
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Read S, MacBride-Stewart S. The ‘good death’ and reduced capacity: a literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/13576275.2017.1339676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Simon Read
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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O’Hare AM, Szarka J, McFarland LV, Vig EK, Sudore RL, Crowley S, Reinke LF, Trivedi R, Taylor JS. "Maybe They Don't Even Know That I Exist": Challenges Faced by Family Members and Friends of Patients with Advanced Kidney Disease. Clin J Am Soc Nephrol 2017; 12:930-938. [PMID: 28356337 PMCID: PMC5460720 DOI: 10.2215/cjn.12721216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/21/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Family members and friends of patients with advanced chronic illness are increasingly called on to assist with ever more complex medical care and treatment decisions arising late in the course of illness. Our goal was to learn about the experiences of family members and friends of patients with advanced kidney disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS As part of a study intended to identify opportunities to enhance advance care planning, we conducted semistructured interviews at the Veterans Affairs Puget Sound Health Care System with 17 family members and friends of patients with advanced kidney disease. Interviews were conducted between April of 2014 and May of 2016 and were audiotaped, transcribed, and analyzed inductively using grounded theory to identify emergent themes. RESULTS The following three themes emerged from interviews with patients' family members and friends: (1) their roles in care and planning were fluid over the course of the patient's illness, shaped by the patients' changing needs and their readiness to involve those close to them; (2) their involvement in patients' care was strongly shaped by health care system needs. Family and friends described filling gaps left by the health care system and how their involvement in care and decision-making was at times constrained and at other times expected by providers, depending on system needs; and (3) they described multiple sources of tension and conflict in their interactions with patients and the health care system, including instances of being pitted against the patient. CONCLUSIONS Interviews with family members and friends of patients with advanced kidney disease provide a window on the complex dynamics shaping their engagement in patients' care, and highlight the potential value of offering opportunities for engagement throughout the course of illness.
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Affiliation(s)
- Ann M. O’Hare
- Center of Innovation for Veteran-Centered and Value-Driven Care
- Hospital and Specialty Medicine Service, and
- Departments of Medicine and
| | - Jackie Szarka
- Center of Innovation for Veteran-Centered and Value-Driven Care
| | | | - Elizabeth K. Vig
- Geriatrics and Extended Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Departments of Medicine and
| | - Rebecca L. Sudore
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Susan Crowley
- Veterans Affairs Westhaven and Yale University, New Haven, Connecticut
| | - Lynn F. Reinke
- Center of Innovation for Veteran-Centered and Value-Driven Care
- Hospital and Specialty Medicine Service, and
| | - Ranak Trivedi
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
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O'Rourke G, Methven S, Lloyd L. To Dialyse or not to Dialyse - Is that the Question? A Psychosocial Perspective on Dilemmas Concerning Dialysis for People with Dementia. DEMENTIA 2017; 18:1341-1353. [PMID: 28358271 DOI: 10.1177/1471301217699355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is increasing recognition that the organisation of health care into specialist areas of practice can be counterproductive for older people with multiple morbidities and that dementia can raise particular challenges in health care. In the context of treatment for chronic kidney disease, these challenges concern complex decisions about the suitability and efficacy of dialysis and other treatments. This article draws on a literature review to present a psychosocial perspective on these decisions. It considers the value of the concept of 'dementia friendliness' for nephrology practice and suggests how this could provide a valuable frame of reference for the multidisciplinary nephrology team to ensure they are best equipped to work with people living with dementia and their carers and to ensure that the individual patient is truly at the centre of their treatment regime.
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Ashktorab T, Baghcheghi N, Seyedfatemi N, Baghestani A. Psychometric parameters of the Persian version of the BriefCOPE among wives of patients under hemodialysis. Med J Islam Repub Iran 2017; 31:20. [PMID: 28955670 PMCID: PMC5609324 DOI: 10.18869/mjiri.31.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 11/09/2022] Open
Abstract
Background: The Brief COPE is widely validated and popularly used in assessing coping strategies in major life stressors on various populations. This study carried out to determine the validity and reliability of the Persian version of the Brief COPE among wives of patients under hemodialysis. Methods: The Brief COPE was translated into Persian language according to the standard method and the psychometric properties of the instrument were assessed among 212 wives of patients under hemodialysis in Tehran, Iran, in 2016. Content validity was established, by 15 expert opinions. Face validity was determined by respondents and expert opinion. Construct validity was analyzed through confirmatory factor analysis. The Cronbach's alpha coefficient and intraclass correlation coefficient were used to determine the internal consistency and test-retest reliability, respectively. Results: All 28 Items of Brief COPE scale had content validity index greater than 0.7, suggesting a good validity value of the items in terms of relevancy (range 0.8 - 0.94). The wording of some items was modified to make them more readily understood by the participants, although the core meaning of each item was kept intact and to observe Iranian cultural adaptation; two items were adjusted. Result of confirmatory factor support 14 factor structure of the scale has good fit. Cronbach's alpha coefficient was acceptable for the total scale (α= 0.77) and for subscales (range 0.7 - 0.91). The intraclass correlation coefficient was acceptable for scale (r=0.76, P value= 0.001). Conclusion: The Persian translation of the Brief COPE is a valid and reliable instrument to determine coping strategies in women living with the husband on hemodialysis.
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Affiliation(s)
- Tahereh Ashktorab
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nayereh Baghcheghi
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naimeh Seyedfatemi
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Baghestani
- School of Paramedical Sciences, Shahid Beheshti University of Medical sciences, Tehran, Iran
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Libert Y, Borghgraef C, Beguin Y, Delvaux N, Devos M, Doyen C, Dubruille S, Etienne AM, Liénard A, Merckaert I, Reynaert C, Slachmuylder JL, Straetmans N, Van Den Neste E, Bron D, Razavi D. Factors associated with self-perceived burden to the primary caregiver in older patients with hematologic malignancies: an exploratory study. Psychooncology 2016; 26:118-124. [PMID: 26940829 DOI: 10.1002/pon.4108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although cancer patients frequently experience self-perceived burden to others, this perception has not been enough studied. The aim of this study was to investigate the prevalence of self-perceived burden to the primary caregiver (SPB-PC) and associated factors in an older patient population with hematologic malignancies at the time of chemotherapy initiation. METHODS In total, 166 consecutive patients with hematologic malignancies aged ≥65 years were recruited at the time of chemotherapy initiation. Patients' SPB-PC was assessed using a 100-mm visual analogue scale (VAS). Characteristics potentially associated with SPB-PC, including sociodemographic and medical characteristics, physical functioning status (Karnofsky performance score, activities of daily living (ADL)/instrumental ADL), symptoms (fatigue, pain, nausea, quality of life), psychological distress (Hospital Anxiety and Depression Scale (HADS)), perceived cognitive function (Functional Assessment of Cancer Therapy Cognitive (FACT-Cog) Scale), and patients'/primary caregivers' personal relationship characteristics (family tie, support), were assessed. RESULTS Thirty-five percent of patients reported moderate to severe SPB-PC (VAS ≥ 50 mm). Patients' SPB-PC was associated with lower Karnofsky performance (β = -0.135, p = 0.058) and ADL (β = -0.148, p = 0.037) scores, and higher HADS (β = 0.283, p < 0.001) and FACT-Cog perceived cognitive impairments subscale (β = 0.211, p = 0.004) scores. The proportion of explained variance was 23.5%. CONCLUSIONS Health care professionals should be aware that about one third of older cancer patients experience moderate to severe SPB-PC at the time of chemotherapy initiation. They should adapt their support of patients who report such a feeling. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Brussels, Belgium
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Foley G, Timonen V, Hardiman O. "I hate being a burden": The patient perspective on carer burden in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:351-7. [PMID: 26857752 DOI: 10.3109/21678421.2016.1143512] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Research has shown that family caregivers of ALS patients encounter carer burden. Studies that have investigated the impact of caring on family in ALS have reported predominantly from the family caregiver perspective. We undertook in-depth qualitative interviews with a diverse group of ALS patients (n = 34) sampled from the Irish ALS population-based register and explored their experiences of receiving care from family members and from formal service providers. Interviews were audio recorded and transcribed and data were coded to identify psychosocial processes. Findings showed that patients perceived their care as a burden on family and had concerns about the adverse effects that caring had on family caregivers. However, participants also resisted being a burden on family and they provided emotional support to their family. Participants felt a strong sense of obligation towards family and their concern about family members shaped their expressed preferences for care. We identified that the caring process between ALS patients and their family is often bi-directional, leading in some cases to the patient experiencing carer burden. In conclusion, greater attention in ALS research and practice to patients' supportive roles in family is required to counterbalance the already strong focus on family caregiver burden.
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Affiliation(s)
| | | | - Orla Hardiman
- b Trinity College Dublin and Beaumont Hospital Dublin , Ireland
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Foote C, Kotwal S, Gallagher M, Cass A, Brown M, Jardine M. Survival outcomes of supportive careversusdialysis therapies for elderly patients with end-stage kidney disease: A systematic review and meta-analysis. Nephrology (Carlton) 2016; 21:241-53. [DOI: 10.1111/nep.12586] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Celine Foote
- The George Institute for Global Health; University of Sydney; Sydney Australia
- Renal Department; Concord Repatriation General Hospital; Sydney Australia
| | - Sradha Kotwal
- The George Institute for Global Health; University of Sydney; Sydney Australia
| | - Martin Gallagher
- The George Institute for Global Health; University of Sydney; Sydney Australia
- Renal Department; Concord Repatriation General Hospital; Sydney Australia
- Concord Clinical School; University of Sydney; Sydney Australia
| | - Alan Cass
- The George Institute for Global Health; University of Sydney; Sydney Australia
- Menzies School of Health Research; Charles Darwin University; Darwin Australia
| | - Mark Brown
- Department of Renal Medicine; St George Hospital; Sydney Australia
- Department of Medicine; University of New South Wales; Sydney Australia
| | - Meg Jardine
- The George Institute for Global Health; University of Sydney; Sydney Australia
- Renal Department; Concord Repatriation General Hospital; Sydney Australia
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Chatrung C, Sorajjakool S, Amnatsatsue K. Wellness and Religious Coping Among Thai Individuals Living with Chronic Kidney Disease in Southern California. JOURNAL OF RELIGION AND HEALTH 2015; 54:2198-2211. [PMID: 25300413 DOI: 10.1007/s10943-014-9958-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This qualitative research is based on eight Thai participants living with chronic kidney disease living in Southern California. Four emerging themes are (a) wellness, (b) self-care, (c) impact of illness on life, and (d) religious coping. Family relations, social support, and religious coping affected self-care and how they managed their everyday activities. Knowledge about the disease and its mechanism were crucial to the decision-making process in relation to self-care. Good self-care and appropriate self-management led to wellness and improved quality of life. Religion provided a belief system focusing on the place of acceptance that was essential for coping with emotional stressors.
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Affiliation(s)
- Chutikarn Chatrung
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
| | - Siroj Sorajjakool
- School of Religion, Loma Linda University, Loma Linda, CA, 92350, USA.
| | - Kwanjai Amnatsatsue
- Department of Public Health Nursing, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
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Lim HA, Yu Z, Kang AWC, Foo MWY, Griva K. The Course of Quality of Life in Patients on Peritoneal Dialysis: A 12-month Prospective Observational Cohort Study. Int J Behav Med 2015; 23:507-14. [DOI: 10.1007/s12529-015-9521-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Noble HR, Agus A, Brazil K, Burns A, Goodfellow NA, Guiney M, McCourt F, McDowell C, Normand C, Roderick P, Thompson C, Maxwell AP, Yaqoob MM. PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis. BMC Nephrol 2015; 16:104. [PMID: 26163382 PMCID: PMC4499188 DOI: 10.1186/s12882-015-0084-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/04/2015] [Indexed: 11/23/2022] Open
Abstract
Background The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK. Methods In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists. Discussion The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.
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Affiliation(s)
- Helen Rose Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre: 97 Lisburn Rd, BT9 7BL, Belfast, UK.
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre: 97 Lisburn Rd, BT9 7BL, Belfast, UK
| | - Aine Burns
- Royal Free Hospital, Pond Street, London, NW3 2QN, UK.
| | - Nicola A Goodfellow
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Mary Guiney
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Fiona McCourt
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Charles Normand
- Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
| | - Paul Roderick
- University of Southampton, Mailpoint 805, C floor, South Academic Block, Southampton General Hospital, Southampton, SO166YD, UK.
| | | | - A P Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast & Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK.
| | - M M Yaqoob
- William Harvey Research Institute, Queen Mary University of London, London & Renal Unit, The Royal London Hospital, London, E1 1BB, UK.
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Ho R, Chantagul N. Support for voluntary and nonvoluntary euthanasia: what roles do conditions of suffering and the identity of the terminally ill play? OMEGA-JOURNAL OF DEATH AND DYING 2015; 70:251-77. [PMID: 26036055 DOI: 10.1177/0030222815568958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the level of support for voluntary and nonvoluntary euthanasia under three conditions of suffering (pain; debilitated nature of the body; burden on the family) experienced by oneself, a significant other, and a person in general. The sample consisted of 1,897 Thai adults (719 males, 1,178 females) who voluntarily filled in the study's questionnaire. Initial multivariate analysis of variance indicated significant group (oneself, significant other, person in general) differences in level of support for voluntary and nonvoluntary euthanasia and under the three conditions of suffering. Multigroup path analysis conducted on the posited euthanasia model showed that the three conditions of suffering exerted differential direct and indirect influences on the support of voluntary and nonvoluntary euthanasia as a function of the identity of the person for whom euthanasia was being considered. The implications of these findings are discussed.
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Hussain JA, Flemming K, Murtagh FEM, Johnson MJ. Patient and health care professional decision-making to commence and withdraw from renal dialysis: a systematic review of qualitative research. Clin J Am Soc Nephrol 2015; 10:1201-15. [PMID: 25943310 DOI: 10.2215/cjn.11091114] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/25/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE To ensure that decisions to start and stop dialysis in ESRD are shared, the factors that affect patients and health care professionals in making such decisions must be understood. This systematic review sought to explore how and why different factors mediate the choices about dialysis treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS MEDLINE, Embase, CINAHL, and PsychINFO were searched for qualitative studies of factors that affect patients' or health care professionals' decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. RESULTS Of 494 articles screened, 12 studies (conducted from 1985 to 2014) were included. These involved 206 patients (most receiving hemodialysis) and 64 health care professionals (age ranges: patients, 26-93 years; professionals, 26-61 years). For commencing dialysis, patients based their choice on "gut instinct," as well as deliberating over the effect of treatment on quality of life and survival. How individuals coped with decision-making was influential: Some tried to take control of the problem of progressive renal failure, whereas others focused on controlling their emotions. Health care professionals weighed biomedical factors and were led by an instinct to prolong life. Both patients and health care professionals described feeling powerless. With regard to dialysis withdrawal, only after prolonged periods on dialysis were the realities of life on dialysis fully appreciated and past choices questioned. By this stage, however, patients were physically dependent on treatment. As was seen with commencing dialysis, individuals coped with treatment withdrawal in a problem- or emotion-controlling way. Families struggled to differentiate between choosing versus allowing death. Health care teams avoided and queried discussions regarding dialysis withdrawal. Patients, however, missed the dialogue they experienced during predialysis education. CONCLUSIONS Decision-making in ESRD is complex and dynamic and evolves over time and toward death. The factors at work are multifaceted and operate differently for patients and health professionals. More training and research on open communication and shared decision-making are needed.
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Lee JE, Shin DW, Cho J, Yang HK, Kim SY, Yoo HS, Jho HJ, Shin JY, Cho B, Park K, Park JH. Caregiver burden, patients' self-perceived burden, and preference for palliative care among cancer patients and caregivers. Psychooncology 2015; 24:1545-51. [DOI: 10.1002/pon.3827] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/11/2015] [Accepted: 03/20/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Ji Eun Lee
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Dong Wook Shin
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Juhee Cho
- Cancer Education Center; Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine; Seoul Korea
- Departments of Health, Behavior and Society, and Epidemiology; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul Korea
| | - Hyung Kook Yang
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
| | - So Young Kim
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju-si Korea
| | - Hyo Sang Yoo
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Hyun Jung Jho
- Hospice and Palliative Care Branch, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
| | - Joo Yeon Shin
- Department of Counseling Psychology; Hanyang Cyber University; Seoul Korea
| | - Belong Cho
- Department of Family Medicine/Cancer Survivorship Clinic; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
| | - Keeho Park
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
| | - Jong-Hyock Park
- Division of Cancer Policy, National Cancer Control Institute; National Cancer Center; Goyang-si Korea
- College of Medicine/Graduate School of Health Science Business Convergence; Chungbuk National University; Cheongju-si Korea
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Axelsson L, Klang B, Lundh Hagelin C, Jacobson SH, Andreassen Gleissman S. End of life of patients treated with haemodialysis as narrated by their close relatives. Scand J Caring Sci 2015; 29:776-84. [DOI: 10.1111/scs.12209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Lena Axelsson
- Sophiahemmet University; Stockholm Sweden
- Division of nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Birgitta Klang
- Division of nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Carina Lundh Hagelin
- Sophiahemmet University; Stockholm Sweden
- Department of Learning, Informatics, Management and Ethics; Medical Management Center; Karolinska Institutet; Stockholm Sweden
- Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Stefan H. Jacobson
- Department of Clinical Sciences; Karolinska Institutet; Danderyd University Hospital; Stockholm Sweden
| | - Sissel Andreassen Gleissman
- Sophiahemmet University; Stockholm Sweden
- Department of Clinical Sciences; Karolinska Institutet; Danderyd University Hospital; Stockholm Sweden
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Winterbottom A, Bekker HL, Conner M, Mooney A. Choosing dialysis modality: decision making in a chronic illness context. Health Expect 2014; 17:710-23. [PMID: 22748072 PMCID: PMC5060907 DOI: 10.1111/j.1369-7625.2012.00798.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are encouraged to make an informed decision about dialysis. Survival rates for dialysis are equivalent yet there is wide variation in peritoneal dialysis uptake in the adult UK population. It is unclear how much is attributable to variations in patients' preferences. Kidney function usually declines over months and years; few studies have addressed how a chronic illness context affects choice. This study describes patients' decision making about dialysis and understands how the experience of CKD is associated with treatment choice. METHOD Survey employing interview methods explored 20 patients' views and experiences of making their dialysis choice. Data were analysed using thematic framework analysis to provide descriptive accounts of how patients experienced their illness and made treatment decisions. RESULTS Patients talked about challenges of living with CKD. Patients were provided with lots of information about treatment options in different formats. Patients did not distinguish between different types of dialysis and/or have an in-depth knowledge about options. Patients did not talk about dialysis options as a choice but rather as a treatment they were going to have. CONCLUSION Most patients perceived their choice as between 'dialysis' and 'no dialysis'. They did not perceive themselves to be making an active choice. Possibly, patients feel they do not need to engage with the decision until symptomatic. Despite lots of patient information, there were more opportunities to encounter positive information about haemodialysis. A more proactive approach is required to enable patients to engage fully with the dialysis treatment options.
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Affiliation(s)
- Anna Winterbottom
- Senior Research Fellow, Leeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - Hilary L Bekker
- Senior Lecturer, in Behavioural SciencesLeeds Institute of Health Sciences University of LeedsLeedsUK
| | - Mark Conner
- Professor of Applied Social Psychology, Leeds Institute of Psychological SciencesUniversity of LeedsLeedsUK
| | - Andrew Mooney
- Adult Renal ServicesSt James's University HospitalLeedsUK
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Tong A, Cheung KL, Nair SS, Kurella Tamura M, Craig JC, Winkelmayer WC. Thematic Synthesis of Qualitative Studies on Patient and Caregiver Perspectives on End-of-Life Care in CKD. Am J Kidney Dis 2014; 63:913-27. [DOI: 10.1053/j.ajkd.2013.11.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 11/14/2013] [Indexed: 11/11/2022]
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Axelsson L, Klang B, Lundh Hagelin C, Jacobson SH, Gleissman SA. Meanings of being a close relative of a family member treated with haemodialysis approaching end of life. J Clin Nurs 2014; 24:447-56. [DOI: 10.1111/jocn.12622] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Lena Axelsson
- Sophiahemmet University; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Birgitta Klang
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
| | - Carina Lundh Hagelin
- Sophiahemmet University; Stockholm Sweden
- Department of Learning, Informatics, Management and Ethics; Medical Management Center; Karolinska Institutet; Stockholm Sweden
| | - Stefan H Jacobson
- Division of Nephrology; Department of Clinical Sciences; Danderyd University Hospital; Karolinska Institutet; Stockholm Sweden
| | - Sissel Andreassen Gleissman
- Sophiahemmet University; Stockholm Sweden
- Department of Clinical Sciences; Danderyd Hospital; Karolinska Institutet; Stockholm Sweden
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Low J, Myers J, Smith G, Higgs P, Burns A, Hopkins K, Jones L. The experiences of close persons caring for people with chronic kidney disease stage 5 on conservative kidney management: contested discourses of ageing. Health (London) 2014; 18:613-30. [PMID: 24695386 PMCID: PMC4230846 DOI: 10.1177/1363459314524805] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease stage 5 is a global health challenge in the context of population ageing across the world. The range of treatment options available to patients at all ages has increased and includes transplantation and dialysis. However, these options are often seen as inappropriate for older frailer patients who are now offered the option of conservative kidney management, which is presented as a non-invasive alternative to dialysis, involving symptom management and addressing psychosocial needs. In this study, we conducted qualitative interviews with 26 close persons caring for someone with chronic kidney disease stage 5 in the United Kingdom to investigate how conservative kidney management interacted with implicit ideas of ageing, in both the experience of conservative kidney management and the understanding of the prognosis and future care of the kidney disease. Our findings highlighted participant confusion about the nature of conservative kidney management, which stems from an initial lack of clarity about how conservative kidney management differed from conventional treatments for chronic kidney disease stage 5. In particular, some respondents were not aware of the implicit palliative nature of the intervention or indeed the inevitable end-of-life issues. Although these findings can be situated within the context of communication failure, we would further argue that they also bring to the surface tensions in the discourses surrounding ageing and old age, drawing on the use of a ‘natural’ and a ‘normal’ paradigm of ageing. In the context of chronic kidney disease stage 5, more patients are being dialysed at older ages, but conservative kidney management is being advanced as a better option than dialysis in terms of quality of life and experience. However, in doing so, conservative kidney management implicitly draws on a notion of older age that echoes natural ageing rather than advocate a more interventionist approach. The role of discourses of ageing in the provision of treatments for conservative kidney management has not previously been acknowledged, and this article addresses this gap.
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Affiliation(s)
- Joe Low
- University College London, UK
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Bull R, Youl L, Robertson IK, Mace R, Challenor S, Fassett RG. Pathways to palliative care for patients with chronic kidney disease. J Ren Care 2014; 40:64-73. [PMID: 24438676 DOI: 10.1111/jorc.12049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the terminal nature of chronic kidney disease (CKD), end-of-life care planning is often inconsistent and pathways to palliative care are unclear. Health professionals' perceptions of palliative care and the prevailing context may influence their end-of-life decision making. OBJECTIVES To identify predictors of conservative treatment decisions and their associations with referral to palliative care, and to determine the perceptions that health professionals have about the role of palliative care in management of CKD. METHODS A retrospective audit of deceased patients' charts, spanning three years, and a survey of renal healthcare professionals, documenting CKD palliative care practices, knowledge and attitudes was carried out. Records of all patients with CKD dying between 1 January 2006 and 31 December 2008 in Australian regional renal service were audited. Renal staff from the service were surveyed. Logistic regression for binomial outcomes and ordinal logistic regression when more than two outcome levels were involved; and thematic analysis using a continual cross comparative approach was undertaken. RESULTS Loss of function, particularly from stroke, and severe pain are interpreted as representing levels of suffering which would justify the need to withdraw from renal replacement therapy. Family and/or patient indecision complicates and disrupts end-of-life care planning and can establish a cycle of ambiguity. Whilst renal healthcare professionals support early discussion of end-of-life care at predialysis education, congruity with the patient and family when making the final decision is of great importance. CONCLUSION Healthcare professionals' beliefs, values and knowledge of palliative care influence their end-of-life care decisions. The influence of patient, family and clinicians involves negotiation and equivocation. Health professionals support the early discussion of end-of-life care in CKD at predialysis education to enable clearer decision making.
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Affiliation(s)
- Rosalind Bull
- School of Nursing and Midwifery, University of Tasmania, Launceston, Tasmania, Australia
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Tan L, Yong WC, Sim LK, Low J. Renal Replacement Therapy: Why Patients Say “No”. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n12p689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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50
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Urban AK, Brennan F. Patients who withdraw from dialysis in a Sydney centre with palliative care support: who, why, and how do our patients die? PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x12y.0000000045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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