Fahad Saeed , Areeba Jawed , Spencer Dahl , Frances R. Nedjat-Haiem , Paul R. Duberstein , Kevin A. Fiscella , Reza Yousefi Nooraie , Ronald M. Epstein , Rebecca J. Allen
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We evaluated the acceptability of CKD-EDU, a PC-based kidney therapy decision support intervention for adults<!--> <!-->≥75 years of age.</p></div><div><h3>Study Design</h3><p>Qualitative study.</p></div><div><h3>Setting & Participants</h3><p>Two trained research coordinators interviewed patients and nephrologists participating in the CKD-EDU study.</p></div><div><h3>Analytical Approach</h3><p>Three coders analyzed the qualitative data using a thematic analysis approach to identify salient themes pertaining to intervention acceptability.</p></div><div><h3>Results</h3><p>Patients (n<!--> <!-->=<!--> <!-->19; mean age: 80 years) viewed the PC intervention favorably, noting PC physicians' excellent communication skills, whole-person care, and decision-making support, including comprehension of prognostic information. Nephrologists (n<!--> <!-->=<!--> <!-->24; mean age) welcomed PC assistance in decision making, support for conservative kidney management, and symptom management; a minority voiced concerns about third-party involvement in their practice.</p></div><div><h3>Limitations</h3><p>Single-center study.</p></div><div><h3>Conclusions</h3><p>Overall, patients and nephrologists generally found the PC intervention to be acceptable. Future testing of the current PC-based decision support intervention in a larger randomized controlled trial for older people navigating kidney therapy decisions is needed.</p></div><div><h3>Plain-Language Summary</h3><p>Literature on the acceptability of palliative care for kidney therapy decision making for older adults is scarce. This qualitative study establishes the acceptability of a palliative care (PC)-based kidney therapy decision support pilot intervention among older adults with advanced chronic kidney disease (CKD). Both patients and nephrologists found the intervention acceptable. Future testing of this PC-based intervention in an adequately powered randomized controlled trial for older individuals navigating kidney therapy decisions is needed.</p></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590059524000943/pdfft?md5=ffcd6ae6838bcc87da1b2cfe544f873b&pid=1-s2.0-S2590059524000943-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Palliative Care Acceptability for Older Adults with Advanced CKD: A Qualitative Study of Patients and Nephrologists\",\"authors\":\"Fahad Saeed , Areeba Jawed , Spencer Dahl , Frances R. Nedjat-Haiem , Paul R. Duberstein , Kevin A. Fiscella , Reza Yousefi Nooraie , Ronald M. Epstein , Rebecca J. 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We evaluated the acceptability of CKD-EDU, a PC-based kidney therapy decision support intervention for adults<!--> <!-->≥75 years of age.</p></div><div><h3>Study Design</h3><p>Qualitative study.</p></div><div><h3>Setting & Participants</h3><p>Two trained research coordinators interviewed patients and nephrologists participating in the CKD-EDU study.</p></div><div><h3>Analytical Approach</h3><p>Three coders analyzed the qualitative data using a thematic analysis approach to identify salient themes pertaining to intervention acceptability.</p></div><div><h3>Results</h3><p>Patients (n<!--> <!-->=<!--> <!-->19; mean age: 80 years) viewed the PC intervention favorably, noting PC physicians' excellent communication skills, whole-person care, and decision-making support, including comprehension of prognostic information. Nephrologists (n<!--> <!-->=<!--> <!-->24; mean age) welcomed PC assistance in decision making, support for conservative kidney management, and symptom management; a minority voiced concerns about third-party involvement in their practice.</p></div><div><h3>Limitations</h3><p>Single-center study.</p></div><div><h3>Conclusions</h3><p>Overall, patients and nephrologists generally found the PC intervention to be acceptable. Future testing of the current PC-based decision support intervention in a larger randomized controlled trial for older people navigating kidney therapy decisions is needed.</p></div><div><h3>Plain-Language Summary</h3><p>Literature on the acceptability of palliative care for kidney therapy decision making for older adults is scarce. This qualitative study establishes the acceptability of a palliative care (PC)-based kidney therapy decision support pilot intervention among older adults with advanced chronic kidney disease (CKD). 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引用次数: 0
摘要
理由与目标美国的老年患者接受的肾脏治疗往往与他们的目标不符。姑息治疗（PC）专家是协助患者进行治疗目标讨论和决策支持的专家，但接受过姑息治疗并正在考虑肾脏治疗决策的老年患者及其肾病专家的观点和经验仍未得到探讨。我们评估了 CKD-EDU 的可接受性，这是一种基于 PC 的肾脏治疗决策支持干预措施，适用于年龄≥75 岁的成年人。结果患者（n = 19；平均年龄：80 岁）对 PC 干预评价良好，指出 PC 医生具有出色的沟通技巧、全人护理和决策支持，包括对预后信息的理解。肾病专家（24 人；平均年龄）对 PC 协助决策、支持保守肾脏管理和症状管理表示欢迎；少数人对第三方参与他们的实践表示担忧。未来需要在更大规模的随机对照试验中对当前基于 PC 的决策支持干预进行测试，以帮助老年人做出肾脏治疗决策。这项定性研究确定了晚期慢性肾脏病（CKD）老年人对基于姑息治疗（PC）的肾脏治疗决策支持试点干预的接受度。患者和肾病专家都认为该干预措施可以接受。未来有必要在充分授权的随机对照试验中对这种基于 PC 的干预措施进行测试，以帮助老年人做出肾脏治疗决定。
Palliative Care Acceptability for Older Adults with Advanced CKD: A Qualitative Study of Patients and Nephrologists
Rationale & Objective
Older adults in the United States often receive kidney therapies that do not align with their goals. Palliative care (PC) specialists are experts in assisting patients with the goals of care discussions and decision support, yet views and experiences of older patients who have received PC while contemplating kidney therapy decisions and their nephrologists remain unexplored. We evaluated the acceptability of CKD-EDU, a PC-based kidney therapy decision support intervention for adults ≥75 years of age.
Study Design
Qualitative study.
Setting & Participants
Two trained research coordinators interviewed patients and nephrologists participating in the CKD-EDU study.
Analytical Approach
Three coders analyzed the qualitative data using a thematic analysis approach to identify salient themes pertaining to intervention acceptability.
Results
Patients (n = 19; mean age: 80 years) viewed the PC intervention favorably, noting PC physicians' excellent communication skills, whole-person care, and decision-making support, including comprehension of prognostic information. Nephrologists (n = 24; mean age) welcomed PC assistance in decision making, support for conservative kidney management, and symptom management; a minority voiced concerns about third-party involvement in their practice.
Limitations
Single-center study.
Conclusions
Overall, patients and nephrologists generally found the PC intervention to be acceptable. Future testing of the current PC-based decision support intervention in a larger randomized controlled trial for older people navigating kidney therapy decisions is needed.
Plain-Language Summary
Literature on the acceptability of palliative care for kidney therapy decision making for older adults is scarce. This qualitative study establishes the acceptability of a palliative care (PC)-based kidney therapy decision support pilot intervention among older adults with advanced chronic kidney disease (CKD). Both patients and nephrologists found the intervention acceptable. Future testing of this PC-based intervention in an adequately powered randomized controlled trial for older individuals navigating kidney therapy decisions is needed.
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