Uncovering Patient and Caregiver Goals for Goal-Concordant Care in Kidney Therapy Decisions.
Ramya Sampath, Sandhya Seshadri, Tramanh Phan and 3 others
PMID 38196280WHAT IT FOUND
Older kidney patients and caregivers prioritized current quality of life, feared dialysis burdens, and often deferred decisions.
Many patients had not discussed hopes, goals, or fears with nephrologists, primary care physicians, spouses or partners, or clergy.
Key findings
01Patients and caregivers often wanted to keep daily life as good as it was and avoid dialysis if it would not improve quality of life.
02Many patients and caregivers wanted to prolong life while avoiding dialysis.
03Most patients seldom discussed hopes, goals, and fears with members of their care team, families, and larger communities.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis included only 26 patients and 15 caregivers from the intervention arm, so it cannot describe all older adults considering kidney therapy. It was done at a single academic center, and 76.4% of patients and 80% of caregivers were White, so results may not transfer to other settings or groups. Participants were English-speaking adults aged 75 years or older with advanced chronic kidney disease who had not yet made a kidney therapy decision, so results may not apply to other groups. The original trial was a feasibility pilot, so this analysis cannot establish whether the decision aid affected decisions or outcomes. The coordinator wrote down responses, so exact wording may have been paraphrased. The responses were collected before the palliative care intervention, so they do not show what patients decided or what happened after education.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that a palliative care decision aid improves care that matches patient goals. The responses were collected before the intervention and describe preferences and communication, not outcomes.