Ramer SJ, et al. J Am Soc Nephrol.2018;doi:10.1681/ASN.2018060657.
Study shows patients with CKD and care providers are at odds over life goals
In a survey of older adults with advanced CKD, nearly half indicated maintaining independence was their top health outcome priority — a goal that was at odds with their nephrology providers who were surveyed in the same study.
Most nephrologists believed their patients’ high-priority goal was to stay alive. “Nephrology providers demonstrated limited knowledge of their patients’ priorities,” study co-author Sarah J. Ramer, MD, wrote.
Ramer, from the Icahn School of Medicine at Mount Sinai in New York, and researchers surveyed 271 patients 60 years or older with advanced (stage 4 or 5) non-dialysis-dependent kidney disease who were receiving care at a CKD clinic. Patients were asked to complete a validated health outcome prioritization tool. For each patient, the nephrologist caring for the patient was asked to complete the same survey. Patients also answered questions to assesses their health and completed an end-of-life scenarios instrument.
“We examined the associations between priorities and self-reported health status and between priorities and acceptance of common end-of-life scenarios, and also measured concordance between patients’ priorities and providers’ perceptions of priorities,” the researchers wrote.
Among patients who completed the survey, the top health outcome priority was maintaining independence (49%), followed by staying alive (35%), reducing pain (9%) and reducing other symptoms (6%).
“Nearly half of patients ranked staying alive as the third or fourth priority,” Ramer and colleagues wrote.
After surveying nephrologists about their patients’ top health outcome priorities, respondents were correct 35% of the time.
“Patient-provider concordance for any individual health outcome ranking was similarly poor,” the researchers reported. “To help ensure that care is consistent with patients’ values, nephrology providers should understand their patients’ priorities when they make clinical recommendations.” – by Mark E. Neumann
Disclosures: This work was supported by National Institute of Diabetes and Digestive and Kidney Diseases grants K24 DK62849 (T.A.I.) and K23DK090304 (K.A.-K.) and National Center for Advancing Translational Sciences Clinical and Translational Science Awards UL1TR000445 and UL1TR002243, all from the NIH; the Satellite Health Norman Coplon Extramural Grant Program (K.A.-K.); and the Vanderbilt Center for Kidney Disease. The authors report no relevant financial disclosures.