Gordon E J, Sehgal A R
Department of Medicine, University of Chicago Medical Center, IL 60637-1470, USA.
Adv Ren Replace Ther. 2000 Apr;7(2):177-83. doi: 10.1053/rr.2000.5268.
Little is known about how nephrologists discuss transplantation as a treatment option with end-stage renal disease patients. The authors sought to describe the content and manner of patient-nephrologist discussions about transplantation. Using a cross-sectional study design, we interviewed 79 chronic hemodialysis patients and 12 nephrologists using a semistructured questionnaire that focused on nephrologist and patient reports of discussions about transplantation. The authors found that nephrologists provided information on treatment options gradually over several weeks to months. They generally presented the option of dialysis first, then transplantation, but avoided discussing mortality data. Nephrologists said they encouraged most patients, but especially young patients, to seek transplantation. Of all patients, 68% reported being encouraged to seek transplantation by nephrologists. Low socioeconomic status patients were less likely to report being encouraged to seek transplantation even after adjustment for transplant suitability. Both nephrologists and patients avoided discussing life expectancy data. In conclusion, patient age and socioeconomic status appear to influence discussions of transplantation as a treatment option. Further work is needed to determine how the content and manner of such discussions affect treatment decisions.
关于肾病专家如何与终末期肾病患者讨论将移植作为一种治疗选择，我们了解得很少。作者试图描述医患关于移植讨论的内容和方式。采用横断面研究设计，我们使用一份半结构化问卷对79名慢性血液透析患者和12名肾病专家进行了访谈，该问卷聚焦于肾病专家和患者关于移植讨论的报告。作者发现，肾病专家在数周甚至数月的时间里逐步提供治疗选择的信息。他们通常先介绍透析选项，然后是移植选项，但避免讨论死亡率数据。肾病专家表示，他们鼓励大多数患者，尤其是年轻患者寻求移植。在所有患者中，68%报告称受到肾病专家鼓励去寻求移植。社会经济地位较低的患者即使在调整移植适宜性后，报告称受到鼓励去寻求移植的可能性也较小。肾病专家和患者都避免讨论预期寿命数据。总之，患者年龄和社会经济地位似乎会影响将移植作为一种治疗选择的讨论。需要进一步开展工作来确定此类讨论的内容和方式如何影响治疗决策。
