Raj Rajesh, Thiruvengadam Srivathsan, Ahuja Kiran Deep Kaur, Frandsen Mai, Jose Matthew
Department of Nephrology, Launceston General Hospital, Launceston, Tasmania, Australia
School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
BMJ Open. 2019 Nov 24;9(11):e031427. doi: 10.1136/bmjopen-2019-031427.
This review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.
We followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.
PubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).
Articles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.
Two independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.
248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.
When discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.
本综述总结了可供临床医生向老年肾衰竭患者提供治疗方案咨询的现有信息，重点关注预后、生活质量、治疗的实际体验以及老年人的信息需求。
我们遵循乔安娜·布里格斯研究所的范围综述方法。最终报告符合PRISMA-ScR指南。
PubMed、PsycINFO、CINAHL、Embase、Scopus、Web of Science、TRIP以及在线知识库（用于获取国家肾脏协会的论文、指南和建议）。
2000年1月至2018年8月期间发表的、以英文撰写的、研究晚期肾病老年患者（估计肾小球滤过率<30 mL/min/1.73 m²）的文章。未单独针对老年患者或比较不同透析方式的文章被排除。
两名独立评审员筛选纳入文章，并根据上述目标按主题进行分组。定量数据以表格和图表形式呈现；定性主题被识别和描述。
在筛选了15445条初始结果后，纳入了248篇文章。我们总结了预后评分，并比较了透析和非透析治疗。我们强调了影响生活质量的潜在可改变因素。从实际体验报告中，我们记录了症状、衰老、无力感以及适应需求的影响。对信息需求的探索表明，患者希望参与决策，并且需要简单易懂的关于生存和非生存结果的信息。
在讨论治疗方案时，经过验证的预后评分很有用。患有多种合并症的老年患者透析效果不佳。导致该队列生活质量低下的可改变因素值得关注。老年患者症状负担重、功能衰退；他们必须应对重大的生活变化和无力感。他们希望更多地参与并了解更多关于疾病、症状以及治疗预期的信息。
