Department of Internal Medicine (Nephrology), Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
BMC Nephrol. 2021 Jan 6;22(1):9. doi: 10.1186/s12882-020-02206-9.
Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients' and professionals' experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment.
In this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis.
In six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment.
Patients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD.
患有终末期肾病（ESKD）的老年患者常常存在未被识别的虚弱和多种合并症。尽管有指南建议，但老年评估并不是标准临床护理的一部分，因此错失了改善这些患者（临床）结局包括生活质量的机会。为了为接近 ESKD 的患者制定常规老年评估计划，了解患者和专业人员对老年评估的益处、促进因素和障碍的看法至关重要。
在这项定性研究中，对 ESKD 患者、护理人员和专业人员进行了半结构式焦点小组讨论。参与者是从三个荷兰基于医院的研究和常规护理计划中选择的，这些计划涉及（预）ESKD 护理的老年评估。使用主题分析对转录本进行了归纳分析。
在六次焦点小组中，参与者（n=47）表现出四个主要主题：（1）感知到的老年（预）ESKD 患者群体的特征。患者和专业人员认识到脆弱性增加和（认知）合并症，这通常与日历年龄无关。他们都认为，患者通常需要在各个老年领域得到额外的支持。（2）对老年评估的体验。患者认为老年评估的内容和花费主要是积极的。专业人员强调，评估使整个治疗团队对认知和社会问题有了认识，将重点从主要的躯体问题转移到多维问题上。老年评估的结果被观察到可以加强关于治疗选择的适宜性、（重新）调整治疗以及提供/寻求额外（社会）支持的对话。（3）在常规护理中实施老年评估的障碍和促进因素。讨论的障碍包括缺乏关于目标的沟通和对老年评估的解释、患者的负担、文盲以及组织方面。主要的促进因素是良好的多学科合作、老年医学的参与和多学科团队会议。（4）合适的老年评估的理想特征涉及测试的范围和使用以及评估的时间。
患者和专业人员对在常规肾病护理中使用老年评估持积极态度。一旦克服了障碍并支持了促进因素，实施似乎是可行的。常规护理中的老年评估似乎有希望改善接近 ESKD 的患者的（临床）结局。
