Serious Illness Treatment Preferences for Older Adults with Advanced CKD

Serious Illness Treatment Preferences for Older Adults with Advanced CKD

Patient-centered care for older adults with CKD requires communication about patient's values, goals of care, and treatment preferences. Eliciting this information requires tools that patients understand and that enable effective communication about their care preferences. Nephrology clinic pat...

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Veröffentlicht in:Journal of the American Society of Nephrology 2019-11, Vol.30 (11), p.2252-2261
Hauptverfasser: Baddour, Nicolas Awad, Siew, Edward D, Robinson-Cohen, Cassianne, Salat, Huzaifah, Mason, Olivia J, Stewart, Thomas G, Karlekar, Mohana, El-Sourady, Maie H, Lipworth, Loren, Abdel-Kader, Khaled
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container_end_page 2261
container_issue 11
container_start_page 2252
container_title Journal of the American Society of Nephrology
container_volume 30
creator Baddour, Nicolas Awad
Siew, Edward D
Robinson-Cohen, Cassianne
Salat, Huzaifah
Mason, Olivia J
Stewart, Thomas G
Karlekar, Mohana
El-Sourady, Maie H
Lipworth, Loren
Abdel-Kader, Khaled
description Patient-centered care for older adults with CKD requires communication about patient's values, goals of care, and treatment preferences. Eliciting this information requires tools that patients understand and that enable effective communication about their care preferences. Nephrology clinic patients age ≥60 years with stage 4 or 5 nondialysis-dependent CKD selected one of four responses to the question, "If you had a serious illness, what would be important to you?" Condensed versions of the options were, "Live as long as possible;" "Try treatments, but do not suffer;" "Focus on comfort;" or "Unsure." Patients also completed a validated health outcome prioritization tool and an instrument determining the acceptability of end-of-life scenarios. Patient responses to the three tools were compared. Of the 382 participants, 35% ( =134) selected "Try treatments, but do not suffer;" 33% ( =126) chose "Focus on comfort;" 20% ( =75) opted for "Live as long as possible;" and 12% ( =47) selected "Unsure." Answers were associated with patients' first health outcome priority and acceptability of end-of-life scenarios. One third of patients with a preference to "Focus on comfort" reported that a life on dialysis would not be worth living compared with 5% of those who chose "Live as long as possible" (
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Eliciting this information requires tools that patients understand and that enable effective communication about their care preferences. Nephrology clinic patients age ≥60 years with stage 4 or 5 nondialysis-dependent CKD selected one of four responses to the question, "If you had a serious illness, what would be important to you?" Condensed versions of the options were, "Live as long as possible;" "Try treatments, but do not suffer;" "Focus on comfort;" or "Unsure." Patients also completed a validated health outcome prioritization tool and an instrument determining the acceptability of end-of-life scenarios. Patient responses to the three tools were compared. Of the 382 participants, 35% ( =134) selected "Try treatments, but do not suffer;" 33% ( =126) chose "Focus on comfort;" 20% ( =75) opted for "Live as long as possible;" and 12% ( =47) selected "Unsure." Answers were associated with patients' first health outcome priority and acceptability of end-of-life scenarios. One third of patients with a preference to "Focus on comfort" reported that a life on dialysis would not be worth living compared with 5% of those who chose "Live as long as possible" ( &lt;0.001). About 90% of patients agreed to share their preferences with their providers. Older adults with advanced CKD have diverse treatment preferences and want to share them. 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title Serious Illness Treatment Preferences for Older Adults with Advanced CKD
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