Comparing Nephrologists' Self-Reported Decision-Making Skills and Treatment Attitudes With Their Patients' Experiences of Making Kidney Therapy Decisions and Receiving Nephrology Care.

Areeba Jawed, Brook Batch, Rebecca Allen, Ronald Epstein, Kevin Fiscella, Paul Duberstein, Fahad Saeed
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Abstract

Background: Dialysis is often initiated in the United States without exploring patients' preferred decision-making style, and conservative kidney management (CKM) is infrequently presented. To improve kidney therapy (KT) decision-making, research on nephrologists' comfort with various decision-making styles, attitudes towards CKM, and reports of patients' lived experiences with KT decision-making is needed.

Methods: We surveyed 28 nephrologists and 58 of their patients aged ≥75 years. The nephrologist survey was designed to gauge their comfort levels with decision-making styles and attitudes towards CKM. The patient survey assessed experiences in making KT decisions.

Results: The average age of nephrologists was 43 years, and that of patients was 82 years. Nephrologists rated themselves as comfortable with various decision styles: paternalistic (60.7%), shared decision-making (92.8%), and patient-driven decision-making (67.8%). Nearly 57% of nephrologists felt challenged or were neutral in determining CKM's suitability, and 39% reported difficulties in discussing CKM with patients or were neutral. Only 38 % of patients recalled discussing CKM with their nephrologists, and a minority reported discussing CKM-related topics such as life expectancy (24.7%), quality of life (QOL) (45.1%), and end-of-life care (17.5%).

Conclusions: Most nephrologists displayed comfort with various decision-making styles; however, many described difficulties in guiding patients toward CKM. In contrast, patients reported gaps in vital aspects of KT decision-making and CKM choices, such as discussions of life expectancy, QOL, and end-of-life care. Raising awareness of blind spots in decision-making skills and educating nephrologists in KT decision-making to include CKM and other person-centered aspects of care are needed.

比较肾脏科医生自述的决策技能和治疗态度与患者做出肾脏治疗决定和接受肾脏科护理的经历。
背景:在美国,透析通常是在未探究患者偏好的决策方式的情况下开始的,保守的肾脏管理(CKM)很少被提出。为了改善肾脏治疗(KT)决策,需要对肾病学家对各种决策方式的舒适度、对 CKM 的态度以及患者对 KT 决策的生活体验进行研究:我们调查了 28 位肾科医生及其 58 位年龄≥75 岁的患者。肾科医生调查旨在了解他们对 CKM 决策方式和态度的满意程度。患者调查则评估他们在做出 KT 决策时的经验:结果:肾科医师的平均年龄为 43 岁,患者的平均年龄为 82 岁。肾科医生认为自己能够接受各种决策方式:家长式决策(60.7%)、共同决策(92.8%)和患者主导决策(67.8%)。近 57% 的肾科医生在确定 CKM 是否合适时感到困难重重或持中立态度,39% 的肾科医生表示在与患者讨论 CKM 时遇到困难或持中立态度。只有 38% 的患者回忆起与他们的肾科医生讨论过 CKM,少数患者表示讨论过与 CKM 相关的话题,如预期寿命(24.7%)、生活质量(QOL)(45.1%)和临终关怀(17.5%):结论:大多数肾科医生对各种决策方式感到满意;但是,许多肾科医生在指导患者进行 CKM 时遇到了困难。与此相反,患者表示在 KT 决策和 CKM 选择的重要方面存在差距,如对预期寿命、QOL 和临终关怀的讨论。有必要提高人们对决策技能盲点的认识,并对肾科医生进行 KT 决策方面的教育,以纳入 CKM 和其他以人为本的护理方面。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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