保守治疗的肾衰竭老年人的观点和体验：沟通、信息和决策的定性研究。
The views and experiences of older people with conservatively managed renal failure: a qualitative study of communication, information and decision-making.
机构信息
Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
出版信息
BMC Nephrol. 2019 Feb 4;20(1):38. doi: 10.1186/s12882-019-1230-4.
BACKGROUND
Older people with advanced kidney disease require information and support from clinicians when deciding whether to have dialysis or conservative (non-dialysis) care. There is evidence that communication practices, information provision and treatment rates vary widely across renal units. However, experiences of communicating with clinicians among patients receiving conservative care are poorly understood. This evidence is essential to ensure support is patient-centred and equitable. Our aim was to explore views and experiences of communication, information provision and treatment decision-making among older patients receiving conservative care.
METHODS
In-depth qualitative interviews were conducted with patients with stage 5 chronic kidney disease from three UK renal units. Purposive sampling captured variation in age, co-morbidity and functional status. Interviews were analysed thematically.
RESULTS
20 patients were interviewed (11 were men; median age 82 (range 69-95)). Participants described positive experiences of communicating with clinicians and receiving information, but also negative experiences involving insensitivity, rushing or ambiguity. Participants reported clinicians omitting/avoiding conversations regarding diagnosis and prognosis, and described what helped and hindered good communication and support. They wanted information about their treatment options and illness, but expressed ambivalence about knowing details of disease progression. Clinicians' views and recommendations regarding treatment influenced patients' decision-making.
CONCLUSIONS
Older patients report variable quality in communication with clinicians and gaps in the information received. Uncertainty about the disease trajectory and patients' ambivalence regarding information makes communication particularly challenging for clinicians. Tailoring information to patient preferences and conveying it clearly and sensitively is critical. Renal clinicians require support and training to ensure decision-making support for older patients is patient-centred. Future research should examine how clinicians' communication practices influence treatment decision-making.
背景
患有晚期肾脏疾病的老年人在决定是否接受透析或保守（非透析）治疗时需要临床医生提供信息和支持。有证据表明，沟通实践、信息提供和治疗率在肾脏单位之间存在很大差异。然而，接受保守治疗的患者与临床医生沟通的经验却知之甚少。这些证据对于确保支持以患者为中心和公平至关重要。我们的目的是探讨接受保守治疗的老年患者在沟通、信息提供和治疗决策方面的观点和经验。
方法
对来自英国三个肾脏单位的 20 名患有 5 期慢性肾病的患者进行了深入的定性访谈。有目的的抽样方法捕获了年龄、合并症和功能状态的差异。采用主题分析法对访谈进行了分析。
结果
共对 20 名患者进行了访谈（11 名男性；中位年龄 82 岁（范围 69-95 岁））。参与者描述了与临床医生沟通和接受信息的积极体验，但也描述了涉及不敏感、仓促或含糊不清的负面体验。参与者报告说，临床医生省略/避免了关于诊断和预后的谈话，并描述了有助于和阻碍良好沟通和支持的因素。他们希望获得有关治疗选择和疾病的信息，但对了解疾病进展的细节表示矛盾。临床医生对治疗的看法和建议影响了患者的决策。
结论
老年患者报告说与临床医生沟通的质量存在差异，并且收到的信息存在差距。对疾病轨迹的不确定性和患者对信息的矛盾态度使沟通对临床医生来说极具挑战性。根据患者的偏好调整信息，并清晰、敏感地传达信息至关重要。肾脏临床医生需要得到支持和培训，以确保为老年患者提供以患者为中心的决策支持。未来的研究应研究临床医生的沟通实践如何影响治疗决策。
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