In search of common ground - nephrologists' experiences in preparing and informing patients on the path to end-stage kidney disease.

IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY
Jenny Lindberg, Mats Johansson, Linus Broström
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Abstract

Background: Patient education and dialogue are important when choosing a future treatment strategy for patients with chronic kidney disease. To support patients in their decision-making process, it is critical to provide information in a way that patients can understand. This study was conducted to understand how nephrologists view the goals of information sharing, the challenges involved, and the strategies used as part of treatment planning.

Methods: This study had a qualitative design using semi-structured interviews with 14 practicing nephrologists working in different hospitals in Sweden and with experience in providing information to patients approaching the need for dialysis. The interviews were conducted in 2022. The data were analyzed using qualitative content analysis.

Results: The results are presented thematically under the headings Objectives, Content, Challenges, and Strategies. Participants tried to find common ground with patients, in terms of shared knowledge, shared views on the appropriate decision-making process, and ultimately also agreement on which treatment option was best. There was a tension between allowing patients to make their own decisions and guiding patients to make decisions with the best outcomes as judged by the nephrologist. Achieving common ground was not always possible, both because of factors related to the patient's preferences or limited capacity, and because of boundaries set by the physician to protect the patient from unwarranted or harmful information. Dealing with competing sources of information was seen as challenging. The nephrologists felt a professional responsibility for their treatment recommendations, combined with uncertainty about which patient would benefit from dialysis and when to start.

Conclusions: Planning future treatment for patients with chronic kidney disease involves a complex information process that leaves room for both paternalism and respect for autonomy. Nephrologists face many competing challenges when discussing treatment options with patients. These challenges should be taken into account in the development of support for nephrologists in the area of information sharing.

在寻找共同点-肾脏病专家的经验,在准备和告知病人的道路终末期肾脏疾病。
背景:在选择慢性肾脏疾病患者的未来治疗策略时,患者教育和对话是重要的。为了支持患者的决策过程,以患者能够理解的方式提供信息至关重要。本研究旨在了解肾病学家如何看待信息共享的目标、所涉及的挑战以及作为治疗计划一部分的策略。方法:本研究采用定性设计,采用半结构化访谈,采访了14名在瑞典不同医院工作的执业肾病学家,他们在为接近透析需求的患者提供信息方面具有经验。采访是在2022年进行的。采用定性内容分析法对数据进行分析。结果:结果按主题分为目标、内容、挑战和策略。与会者试图找到与患者的共同点,包括分享知识,分享对适当决策过程的看法,并最终就哪种治疗方案是最好的达成一致。在允许患者自己做决定和指导患者根据肾病专家的判断做出最佳结果的决定之间存在紧张关系。达成共识并不总是可能的,一方面是因为病人的偏好或能力有限,另一方面是因为医生为保护病人不受不合理或有害信息的影响而设定的界限。处理相互竞争的信息来源被视为具有挑战性。肾科医生对他们的治疗建议负有专业责任,同时也不确定哪些患者会从透析中受益,以及何时开始透析。结论:慢性肾脏疾病患者的未来治疗计划涉及一个复杂的信息过程,为家长作风和尊重自主权留下了空间。肾病学家在与患者讨论治疗方案时面临许多相互竞争的挑战。在信息共享领域对肾病学家的支持发展中应考虑到这些挑战。
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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来源期刊
BMC Nephrology
BMC Nephrology UROLOGY & NEPHROLOGY-
CiteScore
4.30
自引率
0.00%
发文量
375
审稿时长
3-8 weeks
期刊介绍: BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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