Navigating prognostic uncertainty with H.O.P.E.: Caring for elderly patients with chronic kidney disease.
Nataly R Espinoza Suarez, Susan Curtis, Iris Hargraves and 9 others
PMID 41764875WHAT IT FOUND
Older adults with advanced kidney disease wanted clinicians to ask how much prognostic information they wanted, not assume.
Some wanted direct early talk; others wanted delay until they asked. Nurses can offer support, plain language, and hope without forcing disclosure.
Key findings
01In 28 interviews, three themes emerged about prognostic conversations: patient choice, timing, and humanistic clinician qualities.
02Patients wanted clinicians to ask how much prognostic information they wanted, and some wanted it delayed until they asked.
03Participants valued strong rapport, sincere care, and time to listen from clinicians.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at a single US tertiary referral centre, so the findings may not transfer to other care settings or populations. Participants had to speak English, had not started dialysis or had a kidney transplant, and had no moderate cognitive impairment, so people with cognitive impairment or established dialysis or transplant care were not represented. The sample was predominantly white and male, which may limit transferability. H.O.P.E. was proposed from the data and was not validated or tested with patients. Family members participated in some interviews, and the paper does not describe how their presence affected the themes.
Declared interests
The authors declared no known competing financial interests or personal relationships that could have appeared to influence the work.
The easy way to misread this
Do not read H.O.P.E. as a validated communication framework. It emerged from these interviews and has not been tested or validated.