More than half of patients reported conflicting decisions about methods of renal failure

September 14, 2022

2 minutes to read

Disclosures:
DePasquale does not report any relevant financial disclosures.


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Published data indicate that the high prevalence of patients with chronic kidney disease indicates a critical struggle around the treatment of renal failure, regardless of the risk of developing renal failure. Nephrology.

Furthermore, patients who attended treatment classes and reported greater satisfaction with the discussions they had with caregivers were less likely to experience conflict in making decisions about treatment.

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Also, patients who attended treatment classes and reported greater satisfaction with the discussions they had with their caregivers were less likely to experience conflict in making decisions about treatment. Data were derived from DePasquale N, et al. Kidney Med. 2022; doi: 10.1016/j.xkme.2022.100521.

“The primary purpose of this study was to explore critical conflict and to identify associated social, demographic, health, physical, renal care/knowledge problems, and psychosocial patient characteristics among adults with advanced chronic kidney disease who did not implement the decision to treat renal failure,” Nicole DiPasquale, Ph.D., MSPH, of the Department of General Internal Medicine at Duke University School of Medicine, and colleagues wrote. They added, “By clarifying the associations between non-modifiable patient characteristics (eg, age) and conflicting decisions, this study may facilitate the identification of adults with advanced chronic kidney disease who need or will benefit from additional support during the treatment decision process. Likewise, The identification of associated modifiable patient characteristics (eg, knowledge of chronic kidney disease) may help inform the goal Intervention Efforts To reduce critical conflict and its ultimate effects.”

In a cross-sectional study, researchers assessed critical conflict among 427 adults (mean age was 71.6 years; 60% women; 97% were non-Hispanic white) with advanced CKD, none of whom had a history of dialysis or transplantation, and a group A subset of 171 adults are at greatest risk of developing kidney failure within two years.

The researchers used “sure of myself”. understanding the information; The risk-benefit ratio is an encouraging (certified) screening test to determine each patient’s decision conflict about treatment modalities for renal failure. Patients answered “yes” or “no” to questions about kidney care in which “yes” equals a score of 1 (no decision conflict) and “no” or “I don’t know” equals zero (decision conflict). The researchers then added scores that ranged from 0 to 4. A score of 4 was considered ideal, and scores less than 3 meant that providers should help patients make decisions about their care.

Through surveys and electronic health records, researchers determined patients’ sociodemographic knowledge, physical health, knowledge of kidney disease care, and psychosocial characteristics.

Using multivariate logistic regression, the researchers measured the relationship between participant characteristics and decision conflict. Analyzes were repeated among a subgroup of patients.

Overall, 76% of patients reported conflicting decisions regarding treatment. Analyzes revealed that patients who reported being completely satisfied with patient and renal team treatment discussions and attending treatment education classes had 84% and 62% lower odds of conflicting decisions. In addition, those with greater self-efficacy in decision-making regarding treatment were less likely to report a decision conflict. The subgroup showed that decision conflict was prevalent among CKD patients, regardless of progression risk.

‘Efforts to Reduce critical conflict Emphasis should be placed on timely treatment education, person-centered treatment discussions and the incorporation of strategies for enhancing decision self-efficacy into decision support mechanisms,” DePasquale and colleagues write.