Health Outcome Preferences and Trade-Offs Among Older Adults With Advanced CKD: A Discrete Choice Experiment.

RATIONALE & OBJECTIVE Decision making for the treatment of kidney failure in older adults, should incorporate patient preferences. This discrete choice experiment (DCE) aimed to identify the health outcome preferences of older patients with chronic kidney disease (CKD) who are at elevated risk of kidney failure. STUDY DESIGN DCE questionnaire development and application. SETTING & PARTICIPANTS Persons aged 65 years and older with CKD stage four or five treated in an outpatient clinic. EXPOSURE Five questionnaire attributes: fatigue, life expectancy, level of independence, hospital admissions, and hospital visits. OUTCOMES Patients' health outcome priorities (relative importance of attributes) and the tradeoffs they were willing to make (marginal rates of substitution). ANALYTICAL APPROACH DCE design based on qualitative research, literature review, and pilot testing (n=14). Data were analyzed using a logistic regression analysis. Interactions between age subgroups were explored using logistic regression models. RESULTS 85 patients completed the questionnaire (mean age 77 years; 65% male). Fatigue had the greatest influence on patients' choices (relative importance 26%), followed by life expectancy (23%), hospital admissions (20%), level of independence (16%), and hospital visits (15%). To avoid fatigue, patients were willing to accept a 46% decrease in three-year survival probability, five extra hospital admissions per year, or 86 extra hospital visits per year. Among patients aged ≥85 years, avoiding hospital admissions was the top health outcome priority, while among patients aged 65-74 years, it was the lowest-ranked attribute. LIMITATIONS Participants were required to return the questionnaire independently. Subgroups may have been too small to detect all significant differences. CONCLUSIONS Fatigue and life expectancy were the top health outcome priorities of older people with advanced CKD. Avoiding hospital admissions was the top priority among the oldest patients. These findings inform the choice of patient-centered outcomes in research and clinical practice for older patients with CKD.