Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Am J Kidney Dis. 2024 Feb;83(2):173-182.e1. doi: 10.1053/j.ajkd.2023.07.013. Epub 2023 Sep 17.
RATIONALE & OBJECTIVE: Kidney transplant patients with failing allografts have a physical and psychological symptom burden as well as high morbidity and mortality. Palliative care is underutilized in this vulnerable population. We described kidney transplant clinicians' perceptions of palliative care to delineate their perceived barriers to and facilitators of providing palliative care to this population.
National explanatory sequential mixed methods study including an online survey and semistructured interviews.
SETTING & PARTICIPANTS: Kidney transplant clinicians in the United States surveyed and interviewed from October 2021 to March 2022.
Descriptive summary of survey responses, thematic analysis of qualitative interviews, and mixed methods integration of data.
A total of 149 clinicians completed the survey, and 19 completed the subsequent interviews. Over 90% of respondents agreed that palliative care can be helpful for patients with a failing kidney allograft. However, 46% of respondents disagreed that all patients with failing allografts benefit from palliative care, and two-thirds thought that patients would not want serious illness conversations. More than 90% of clinicians expressed concern that transplant patients and caregivers would feel scared or anxious if offered palliative care. The interviews identified three main themes: (1) transplant clinicians' unique sense of personal and professional responsibility was a barrier to palliative care engagement, (2) clinicians' uncertainty regarding the timing of palliative care collaboration would lead to delayed referral, and (3) clinicians felt challenged by factors related to patients' cultural backgrounds and identities, such as language differences. Many comments reflected an unfamiliarity with the broad scope of palliative care beyond end-of-life care.
Potential selection bias.
Our study suggests that multiple barriers related to patients, clinicians, health systems, and health policies may pose challenges to the delivery of palliative care for patients with failing kidney transplants. This study illustrates the urgent need for ongoing efforts to optimize palliative care delivery models dedicated to kidney transplant patients, their families, and the clinicians who serve them.
PLAIN-LANGUAGE SUMMARY: Kidney transplant patients experience physical and psychological suffering in the context of their illnesses that may be amenable to palliative care. However, palliative care is often underutilized in this population. In this mixed-methods study, we surveyed 149 clinicians across the United States, and 19 of them completed semistructured interviews. Our study results demonstrate that several patient, clinician, system, and policy factors need to be addressed to improve palliative care delivery to this vulnerable population.
移植肾失功的患者承受着身体和心理上的双重负担，且发病率和死亡率较高。姑息治疗在这一脆弱人群中应用不足。本研究旨在描述移植肾临床医生对姑息治疗的看法，以明确他们认为为该人群提供姑息治疗的障碍和促进因素。
本研究是一项包括在线调查和半结构式访谈的全国性解释性序贯混合方法研究。
2021 年 10 月至 2022 年 3 月，我们对美国的移植肾临床医生进行了调查和访谈。
对调查结果进行描述性总结，对定性访谈进行主题分析，并对数据进行混合方法整合。
共有 149 名临床医生完成了调查，其中 19 名完成了后续访谈。超过 90%的受访者认为姑息治疗对移植肾失功患者有帮助。然而，46%的受访者认为并非所有移植肾失功患者都受益于姑息治疗，三分之二的人认为患者不会接受严重疾病的相关讨论。超过 90%的临床医生表示担心提供姑息治疗会使移植患者及其照顾者感到恐惧或焦虑。访谈确定了三个主要主题：（1）移植临床医生独特的个人和专业责任感是参与姑息治疗的障碍；（2）临床医生对姑息治疗合作时机的不确定性会导致延迟转诊；（3）临床医生感到患者的文化背景和身份相关因素带来挑战，如语言差异。许多评论反映出对姑息治疗除临终关怀以外的广泛范围不熟悉。
可能存在选择偏倚。
本研究表明，与患者、临床医生、医疗体系和卫生政策相关的多个障碍可能对移植肾失功患者的姑息治疗带来挑战。本研究表明，迫切需要持续努力优化专门针对移植肾患者、其家属以及为他们服务的临床医生的姑息治疗提供模式。
