University of Michigan KECC, Ann Arbor, MI.
The Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI.
Am J Kidney Dis. 2016 Dec;68(6):901-910. doi: 10.1053/j.ajkd.2016.05.010. Epub 2016 Jun 21.
Little is known about factors that are important to patients with advanced kidney disease and their perspectives at the time they choose a dialysis modality. EPOCH-RRT, a study supported in part by the Patient-Centered Outcomes Research Institute (PCORI), was designed to assist patients with this choice by identifying such factors and effectively provide relevant information.
Cross-sectional study, designed and conducted in collaboration with a multistakeholder advisory panel that included patients, caregivers, and health care professionals.
SETTING & PARTICIPANTS: 180 patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate < 25mL/min/1.73m), either non-dialysis-dependent (NDD-CKD; n=65) or on dialysis therapy (hemodialysis [HD], n=77; or peritoneal dialysis, n=38), recruited across the United States through social media and in-person contacts.
Semistructured telephone interviews including open- and closed-ended questions.
Mixed methods, integrating quantitative and qualitative approaches; themes identified through content analysis of interview transcripts by 2 independent coders.
Themes most often reported as important were keeping as much independence as possible, quality and quantity of life, and flexibility in daily schedule. Other factors (eg, concern about the way they look) differed across patient subgroups based on age, sex, and NDD-CKD/dialysis modality. Among patients who had initiated dialysis therapy, almost half (47%) the HD patients believed that the decision to be treated by HD had largely not been their choice; this was only reported by 3% of peritoneal dialysis patients.
Recruitment through social media and willingness to participate in lengthy telephone interviews resulted in a select sample that may not be representative of the broader advanced CKD population; therefore, generalizability of findings cannot be determined.
Incorporation of patient priorities in care improves health outcomes. Given the perceived limited role in the choice of dialysis treatment, our findings support the need for interventions to improve shared decision making on dialysis treatment options, targeting both patients and clinicians.
对于患有晚期肾病的患者及其在选择透析方式时的观点而言，重要的因素知之甚少。EPOCH-RRT 研究部分得到了患者中心结局研究所（PCORI）的支持，旨在通过确定这些因素并有效提供相关信息来帮助患者做出选择。
这是一项横断面研究，与包括患者、护理人员和医疗保健专业人员在内的多方利益相关者咨询小组合作设计和进行。
在美国通过社交媒体和面对面接触，共招募了 180 名患有晚期慢性肾脏病（CKD；估计肾小球滤过率 < 25mL/min/1.73m）的患者，其中非透析依赖性 CKD（NDD-CKD；n=65）或正在接受透析治疗（血液透析 [HD]，n=77；或腹膜透析，n=38）。
半结构化电话访谈，包括开放式和封闭式问题。
混合方法，整合定量和定性方法；通过两位独立编码员对访谈记录的内容分析确定主题。
最常报告为重要的主题是尽可能保持独立性、生活质量和灵活性。其他因素（例如，担心自己的外表）因患者的年龄、性别和 NDD-CKD/透析方式而异。在已经开始透析治疗的患者中，近一半（47%）的 HD 患者认为接受 HD 治疗的决定主要不是他们的选择；只有 3%的腹膜透析患者报告了这一点。
通过社交媒体招募和愿意参加冗长的电话访谈导致选择的样本可能不能代表更广泛的晚期 CKD 人群；因此，无法确定研究结果的普遍性。
将患者的优先事项纳入护理中可以改善健康结果。鉴于在选择透析治疗方面的作用有限，我们的研究结果支持需要干预措施来改善关于透析治疗方案的共同决策，针对患者和临床医生。
