Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
J Ren Care. 2024 Jun;50(2):112-127. doi: 10.1111/jorc.12466. Epub 2023 Apr 8.
Dialysis might not benefit all older patients with kidney failure, particularly those with multimorbid conditions and frailty. Patients' and healthcare professionals' awareness of the presence of geriatric impairments could improve outcomes by tailoring treatment plans and decisions for individual patients.
We aimed to explore the perspectives of patients and healthcare professionals on nephrology-tailored geriatric assessment to fuel decision-making for treatment choices in older patients with kidney failure.
In an exploratory qualitative study using focus groups, participants discussed perspectives on the use and value of nephrology-tailored geriatric assessment for the decision-making process to start or forego dialysis.
Patients (n = 18) with kidney failure, caregivers (n = 4), and professionals (n = 25) were purposively sampled from 10 hospitals. Interviews were audio-recorded, transcribed verbatim and inductively analysed using thematic analysis.
Three main themes emerged that supported or impeded decision-making in kidney failure: (1) patient psycho-social situation; (2) patient-related factors on modality choice; (3) organisation of health care. Patients reported feeling vulnerable due to multiple chronic conditions, old age, experienced losses in life and their willingness to trade longevity for quality of life. Professionals recognised the added value of nephrology-tailored geriatric assessment in three major themes: (i) facilitating continual holistic assessment, (ii) filling the knowledge gap, and (iii) uncovering important patient characteristics.
nephrology-tailored geriatric assessment was perceived as a valuable tool to identify geriatric impairments in older patients with kidney failure. Integration of its outcomes can facilitate a more holistic approach to inform choices and decisions about kidney replacement therapy.
透析可能对所有肾衰竭的老年患者都没有益处，尤其是那些患有多种合并症和衰弱的患者。患者和医疗保健专业人员对老年病损的认识可以通过为个体患者量身定制治疗计划和决策来改善治疗结果。
我们旨在探讨患者和医疗保健专业人员对肾脏病学量身定制的老年评估的看法，以推动为肾衰竭老年患者的治疗选择做出决策。
在一项使用焦点小组的探索性定性研究中，参与者讨论了使用和重视肾脏病学量身定制的老年评估来启动或放弃透析的决策过程的看法。
从 10 家医院中，有目的地抽取了 18 名肾衰竭患者（n=18）、4 名照顾者（n=4）和 25 名专业人员（n=25）。对访谈进行了录音、逐字转录，并使用主题分析进行了归纳分析。
出现了三个支持或阻碍肾衰竭决策的主要主题：（1）患者心理社会状况；（2）患者对治疗方式选择的相关因素；（3）医疗保健组织。患者报告由于多种慢性疾病、年老、生活中的损失以及他们愿意用寿命换取生活质量，感到脆弱。专业人员在三个主要主题中认识到肾脏病学量身定制的老年评估的附加值：（i）促进持续的整体评估；（ii）填补知识空白；（iii）揭示重要的患者特征。
肾脏病学量身定制的老年评估被认为是识别肾衰竭老年患者老年病损的有价值工具。整合其结果可以促进更全面的方法，为肾脏替代治疗的选择和决策提供信息。
