James Laura, Wong Germaine, Craig Jonathan C, Howard Kirsten, Howell Martin, Tong Allison
Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Nephrology (Carlton). 2019 Apr;24(4):414-421. doi: 10.1111/nep.13269.
Patients with chronic kidney disease (CKD) have an increased risk of cancer compared with the general population. Despite this, there is considerable variability in cancer screening practices among nephrologists that may reflect uncertainties about the benefits and harms of screening, the additional costs, and competing priorities among the complex issues that patients are confronted with. We aimed to describe nephrologists' perspectives and approaches to cancer screening in CKD.
Semi-structured interviews were conducted with 29 nephrologists from 15 units across Australia and New Zealand. Interviews were transcribed and thematically analyzed.
Five themes were identified: empowering patients to make informed decisions (respecting patient preferences, communicating evidence-based recommendations, creating awareness of consequences, preparing for transplantation); justifiable risk taking (avoiding undue consequences in vulnerable populations, balancing the costs and benefits, warranted by long term immunosuppression, assurance of reasonable survival gains); ambiguity of evidence in supporting decisions (absence of standardized recommendations, limited transferability of population-based data); depending on a shared multidisciplinary approach (collaboration with primary health care, access to coordinated skin cancer clinics); and prioritizing current or imminent complications.
Nephrologists approach decisions about cancer screening in patients with CKD based on patient preferences, assessment of risk, justifiable survival gains, and current health priorities. Evidence-based guidelines, communication frameworks and specialist clinics may support informed and shared decision making about cancer screening in CKD.
与普通人群相比，慢性肾脏病（CKD）患者患癌风险增加。尽管如此，肾病学家在癌症筛查实践方面存在很大差异，这可能反映出对筛查利弊、额外成本以及患者面临的复杂问题中的相互竞争的优先事项存在不确定性。我们旨在描述肾病学家对CKD患者癌症筛查的观点和方法。
对来自澳大利亚和新西兰15个单位的29名肾病学家进行了半结构化访谈。访谈内容进行了转录并进行了主题分析。
确定了五个主题：使患者能够做出明智的决定（尊重患者偏好、传达基于证据的建议、提高对后果的认识、为移植做准备）；合理冒险（避免在弱势群体中产生不当后果、平衡成本和收益、长期免疫抑制有必要、确保有合理的生存获益）；支持决策的证据不明确（缺乏标准化建议、基于人群的数据可转移性有限）；依赖多学科共同方法（与初级卫生保健合作、进入协调的皮肤癌诊所）；以及优先处理当前或即将出现的并发症。
肾病学家在决定CKD患者的癌症筛查时，基于患者偏好、风险评估、合理的生存获益以及当前的健康优先事项。基于证据的指南、沟通框架和专科诊所可能有助于就CKD患者的癌症筛查做出明智且共同的决策。
