Wong Susan P Y, Chotivatanapong Julie, Lee Deborah, Lam Daniel Y, van Eijk Marieke S
Department of Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, Washington.
Department of Medicine, University of Washington, Seattle, Washington.
Clin J Am Soc Nephrol. 2024 Oct 1;19(10):1284-1291. doi: 10.2215/CJN.0000000000000522. Epub 2024 Jul 18.
Many nephrology providers express difficulty in discussing care options for patients who forgo KRT, which hampers their ability to help patients make decisions about their current and future treatment of kidney disease.
We conducted a qualitative study using interviews with a national sample of nephrology providers (i.e., physicians and advanced practice providers) who participated in US professional societies between July and December 2022. We performed a thematic analysis of interviews to identify emergent themes reflecting providers' experiences discussing care for patients who forgo KRT.
There were 21 providers (age 54±13 years, female 81%, White 32%) who participated in interviews, of whom 43% were physicians and most (57%) practiced in academic settings. Three dominant themes emerged from interviews reflecting challenges to discussing the option to forgo KRT: (1) Inconsistent terminology: while providers sought to use terms to describe care for patients who forgo KRT that affirmed patients' decision, clearly conveyed that KRT would not be pursued, and were already familiar to patients and other providers, they disagreed about which terms satisfied these priorities; (2) blurred distinctions between KRT and its alternative: providers' descriptions of their care practices suggested that differences in their approaches to caring for patients who forgo KRT and those who are planning to pursue KRT could be opaque; and (3) deciphering patients' decision to forgo KRT: providers did not readily accept patients' expressed preferences to forgo KRT at face value and described using a variety of methods to assess whether patients would follow through with their decision.
Providers used different, inconsistent terms to describe care for patients who forgo KRT. They disagreed about what this care entailed and were uncertain about what patients might mean when they express not wanting to undergo KRT.
许多肾脏病医疗服务提供者表示，在讨论放弃肾脏替代治疗（KRT）的患者的护理方案时存在困难，这妨碍了他们帮助患者就其当前和未来的肾脏疾病治疗做出决策的能力。
我们进行了一项定性研究，对2022年7月至12月期间参与美国专业协会的全国肾脏病医疗服务提供者（即医生和高级执业提供者）样本进行访谈。我们对访谈进行了主题分析，以确定反映提供者在讨论放弃KRT患者护理方面经验的新出现主题。
共有21名提供者（年龄54±13岁，女性占81%，白人占32%）参与了访谈，其中43%为医生，大多数（57%）在学术环境中执业。访谈中出现了三个主要主题，反映了在讨论放弃KRT选项时面临的挑战：（1）术语不一致：虽然提供者试图使用术语来描述对放弃KRT的患者的护理，这些术语要肯定患者的决定、清楚地表明不会进行KRT，并且患者和其他提供者已经熟悉，但他们对于哪些术语满足这些优先事项存在分歧；（2）KRT与其替代方案之间的区别模糊：提供者对其护理实践的描述表明，他们对放弃KRT的患者和计划进行KRT的患者的护理方法差异可能不明显；（3）解读患者放弃KRT的决定：提供者不会轻易接受患者表面上表达的放弃KRT的偏好，并描述了使用各种方法来评估患者是否会坚持他们的决定。
提供者使用不同的、不一致的术语来描述对放弃KRT的患者的护理。他们对这种护理的具体内容存在分歧，并且在患者表示不想接受KRT时不确定患者的意思。
