Breaking News
August 21, 2018 - National Foundation for Cancer Research receives Safeway Foundation grant
August 21, 2018 - Protein aggregation in neurons linked to gene regulation in Huntington’s disease
August 21, 2018 - Aravive Biologics gains Fast Track Designation for AVB-S6-500 from U.S. FDA
August 21, 2018 - FDA Approves Opdivo (nivolumab) for Certain Patients with Previously Treated Small Cell Lung Cancer
August 21, 2018 - Success of blood test for autism affirmed
August 21, 2018 - Diabetic patients with disrupted sleep may need more time to heal their wounds
August 21, 2018 - AADE honors six educators for achievements in diabetes education
August 21, 2018 - Scientists find two molecules that may combat cancer and chronic infections
August 21, 2018 - Two Strategies for Preventing Diabetes in Minority Patients
August 21, 2018 - Living as a Gallbladder Cancer Survivor
August 21, 2018 - Can we predict the long-term outcome of boys with ADHD?
August 21, 2018 - GBCA creates model for developing scientist-advocate collaborations in cancer research
August 21, 2018 - Healthy diet could help promote healthy cellular aging in women
August 21, 2018 - Researchers develop gene expression predictor for immunotherapy response in melanoma
August 21, 2018 - MDI Biological Laboratory introduces Morris Scientific Discovery Fund for eligible research programs
August 21, 2018 - Micro-flow model reveals complex interactions between the brain’s blood vessels and nerve cells
August 21, 2018 - Study investigates impact of osteoporosis on risk of developing dementia
August 21, 2018 - Federal method fails to detect most stores that sell cigarettes to minors
August 21, 2018 - Workers in open office seating have less stress than those in private offices and cubicles
August 21, 2018 - 1 in 4 in U.S. Has a Disability, CDC Reports
August 21, 2018 - Studies provide new insights into the role of sleep in chronic pain
August 21, 2018 - Study shows that rogue proteins may underlie some ALS and frontotemporal dementia cases
August 21, 2018 - Elevated LDL cholesterol levels linked to higher risk of CVD death in young, healthy people
August 21, 2018 - Measles cases on the rise in Europe
August 21, 2018 - CURE Media Group welcomes CancerCare to Strategic Alliance Partnership Program
August 21, 2018 - Blood management program associated with fewer transfusions in orthopedic patients
August 21, 2018 - Researchers create the world’s first artificial retina
August 21, 2018 - Yale researchers identify racial disparities in prescribing opioids for chronic pain
August 21, 2018 - BOOST-3 clinical trial aims to improve outcomes for severe TBI patients
August 21, 2018 - New study highlights Alzheimer’s herpes link, experts say
August 21, 2018 - Airline crew don’t have significantly elevated risk of thyroid cancer, new study finds
August 21, 2018 - States leverage federal funds to help insurers lower premiums
August 21, 2018 - New badge course explores research around skeletal muscle as an endocrine organ
August 21, 2018 - TG Therapeutics Announces Completion of Target Enrollment in the ULTIMATE Phase 3 Trials in Multiple Sclerosis
August 21, 2018 - Increased levels of human herpesvirus ID’d in Alzheimer’s
August 21, 2018 - To help patients quash pain, researcher develops practical guide for health care providers
August 20, 2018 - Medicine on the front line to be presented at Medical Innovation 2018
August 20, 2018 - Harbour Biomed and Kelun-Biotech collaborate to develop, commercialize anti-PD-L1 antibody
August 20, 2018 - The man who sold America on vitamin D — and profited in the process
August 20, 2018 - Finding the light in antimicrobials
August 20, 2018 - Unique pain program helps surgical patients wean off opioids safely and effectively
August 20, 2018 - Strawberries could mitigate colonic inflammation
August 20, 2018 - FDA Accepts New Drug Application (NDA) to Review Midazolam Nasal Spray, an Investigational Product for the Acute Treatment of Seizure Clusters
August 20, 2018 - Using Facebook to help young adults quit smoking
August 20, 2018 - ‘Liquid biopsy’ predicts lymphoma therapy success within days | News Center
August 20, 2018 - 5 Questions with Jordan Orange, Chair of Pediatrics
August 20, 2018 - New assay may help improve both sarcoma diagnosis and treatment
August 20, 2018 - New information on the brain regions related to metacognition, tactile sense
August 20, 2018 - New class of insect repellents to fight against mosquito-borne diseases
August 20, 2018 - ACA Coverage Gains Include Workers Without Insurance
August 20, 2018 - 3-D printed biomaterials for bone tissue engineering
August 20, 2018 - Current surveillance system does not quickly pick up most listeriosis cases in the EU, study reveals
August 20, 2018 - Prenatal exposure to acute stress can affect cognitive function in children of low-income households
August 20, 2018 - New study examines scope of state policies targeting drug use by pregnant women
August 20, 2018 - Researchers find long-term structural, functional brain abnormalities in individuals with AUDs
August 20, 2018 - Shortage of insurance fraud cops sparks campaign debate
August 20, 2018 - Researchers find STAT3 as therapeutic target for chronic active EBV infection
August 20, 2018 - Health Tip: Keep Diabetic Feet Healthier
August 20, 2018 - FDA approves brain stimulation device for OCD
August 20, 2018 - NYU Langone’s Perlmutter Cancer Center expands Blood and Marrow Transplant Program
August 20, 2018 - New drug shows potential to prevent painful side effect of therapy
August 20, 2018 - RDMD raises $3 million in seed funding to accelerate rare disease research, drug development
August 20, 2018 - Illicit drug use is higher during celebratory events, may be worse than previously thought
August 20, 2018 - Exploring the relationship between fever and cancer incidence
August 20, 2018 - Study reveals how socioeconomic status affects racial, ethnic disparities in childhood cancer survival
August 20, 2018 - Brain tumors trap immune cells needed to fight cancer in the bone marrow, finds research
August 20, 2018 - Three factors that contribute to physician burnout
August 20, 2018 - Babies dependent on opioids need touch, not tech
August 20, 2018 - Understanding How Antibodies Shape the Gut Microbiome
August 20, 2018 - Cara Therapeutics Doses First Patient in Second Pivotal Phase 3 Efficacy Trial of Korsuva (CR845/difelikefalin) Injection in Hemodialysis Patients with Chronic Kidney Disease-Associated Pruritus
August 20, 2018 - Kidney transplant chains more effective in saving lives
August 20, 2018 - Study unravels cellular and molecular mechanisms behind dermal condensate formation
August 20, 2018 - New integrated gene logic-chips could have great value in medical care
August 20, 2018 - FDA Advisory Committee Recommends Approval of Paratek’s Omadacycline
August 20, 2018 - Total, open repairs decline for abdominal aortic aneurysms
August 20, 2018 - Novel system can pinpoint ingestible implants inside the body using wireless signals
August 20, 2018 - Infection rates of high risk oral HPV in England found to be lower than expected
August 20, 2018 - Making robots as valuable and trustworthy assistants for medical therapies
August 20, 2018 - Patients with low-risk blood clots can be better treated at home than at hospital
August 20, 2018 - Passive smoking exposure among kids greatly increases COPD risk late in life
Researchers investigate how nephrologists should discuss treatment options with older patients

Researchers investigate how nephrologists should discuss treatment options with older patients

image_pdfDownload PDFimage_print

Kidney specialists differ in their approaches to treatment decision-making with older patients with kidney failure, with many nephrologists not describing conservative management and some limiting patients’ role in decision-making, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). Understanding how differences in physicians’ perceptions of their role shape their discussions of the benefits and shortcomings of each approach may help improve care for patients.

Older adults begin dialysis more frequently than any other group in the United States, yet some regret initiating dialysis or think that they do not have a choice in the matter. This suggests that patients may be uninformed about their options and that kidney specialists may have significantly different approaches to explaining dialysis initiation and the decision-making process.

To investigate this issue, Keren Ladin, PhD, MSc (Tufts University) and her colleagues interviewed 35 nephrologists across the United States and asked about what they tell older patients who are facing dialysis decisions and enquired about their standard approach to these types of discussions.

Four different approaches to decision-making were apparent: paternalist, informative (patient-led), interpretive (with doctors as guides steering patients towards an optional treatment), and institutionalist (guided by institutional culture and incentives).

Five themes characterized differences between these approaches regarding how nephrologists prioritized the following:

  • patient autonomy,
  • patient engagement and deliberation (disclosing all options, presenting options neutrally, eliciting patient values, explicit treatment recommendation),
  • the influence of institutional norms,
  • the importance of clinical outcomes (such as survival, dialysis initiation),
  • and physician role (educating patients, making decisions, pursuing active therapies, managing symptoms).

Paternalists and institutionalists viewed initiation of dialysis as a measure of success, while interpretive and informative nephrologists focused on patient engagement, quality of life, and aligning patient values with treatment.

The investigators also found that only one-third of nephrologists presented conservative management to patients, and all of these nephrologists followed either informative or interpretive approaches. The interpretive model best achieved shared decision-making between physician and patient.

“Our findings are important for two reasons,” said Dr. Ladin. “First, understanding the different ways that nephrologists approach decision-making, and identifying the approaches that empower patients to choose the treatment that is most aligned with their preferences may help reduce regret and depression associated with dialysis. Second, characterizing the spectrum of approaches to decision-making and identifying the one that best aligns with shared decision-making may help nephrologists better identify their approach and ways that they could improve to facilitate shared decision-making.”

In an accompanying Patient Voice editorial, Denise Eilers, BSN, RN, provides a perspective based on her dual roles as a registered nurse and a former home hemodialysis care partner for her husband. She noted that the study is especially timely given the large number of aging baby boomers in society. “That generation, of which I am a member, has been described in various terms such as goal oriented, self-sufficient, questioning and involved,” she wrote. “The sheer numbers of these older non-traditional adults will make it necessary to move the needle further toward shared decision-making as in the interpretive model. This study offers a guide from which to develop tools to facilitate discussions.”

Source:

https://www.asn-online.org/

About author

Related Articles