Comrie Cameron E, He Katherine, Wong Jolene, Chandraker Anil K, Murakami Naoka, Lakin Joshua R, Reich Amanda J
Department of Surgery, Massachusetts General Hospital, Boston, MA.
Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Kidney Med. 2024 Oct 16;6(12):100917. doi: 10.1016/j.xkme.2024.100917. eCollection 2024 Dec.
RATIONALE & OBJECTIVE: Nearly half of kidney transplant recipients develop allograft failure within 10 years of transplantation and experience high mortality, significant symptom burden, and complex communication challenges. These patients may benefit from palliative care, but palliative care is infrequently provided in this population. This study explores palliative care perceptions and needs among patients with poorly functioning and declining kidney allografts.
A qualitative study using semistructured interviews.
SETTING & PARTICIPANTS: Adult kidney transplant recipients with a glomerular filtration rate of <20 mL/min/1.73m followed at a single transplant center were interviewed from April 2022 to November 2022.
An interdisciplinary team, including nephrology, palliative care, and surgery, conducted a thematic analysis.
Twelve participants (3 women, 9 men; 9 White, 2 Black, and 1 Hispanic patient) were interviewed. The median age of participants was 59 (IQR 48-73). At 6 months postinterview, 7 participants had resumed dialysis, 1 participant had been retransplanted, and 1 participant was deceased. Most participants had not heard of palliative care and those who had equated it with end-of-life care. Participants reported that emotional distress, particularly pervasive concern about the worsening of their kidney disease, was their most significant priority related to unmet palliative care needs. They also desired more discussion with their care team about future quality of life and lifespan. Participants described high trust in their transplant teams, suggesting that palliative care integration with these teams would be well-received.
Limitations include recruitment from a single institution, lack of subject familiarity with palliative care, and limited racial and ethnic diversity among participants.
Patients with declining kidney allografts have heterogeneous, unmet palliative care needs, including emotional symptoms and a desire for better prognostic awareness. Our results suggest that patients are largely unaware of palliative care and may benefit from practice models in which transplant teams integrate palliative care education and timely palliative care engagement.
近一半的肾移植受者在移植后10年内出现移植肾失功，并经历高死亡率、严重的症状负担和复杂的沟通挑战。这些患者可能从姑息治疗中获益，但该人群很少接受姑息治疗。本研究探讨移植肾功能不佳且逐渐下降的患者对姑息治疗的认知和需求。
一项采用半结构式访谈的定性研究。
2022年4月至2022年11月，对在单一移植中心随访的肾小球滤过率<20 mL/min/1.73m²的成年肾移植受者进行了访谈。
一个包括肾脏病学、姑息治疗和外科的跨学科团队进行了主题分析。
对12名参与者（3名女性，9名男性；9名白人，2名黑人，1名西班牙裔患者）进行了访谈。参与者的中位年龄为59岁（四分位间距48 - 73岁）。访谈后6个月，7名参与者恢复了透析，1名参与者接受了再次移植，1名参与者死亡。大多数参与者没有听说过姑息治疗，而那些听说过的人将其等同于临终关怀。参与者报告说，情绪困扰，特别是对肾病恶化的普遍担忧，是他们与未满足的姑息治疗需求相关的最主要问题。他们还希望与护理团队更多地讨论未来的生活质量和寿命。参与者表示对他们的移植团队高度信任，这表明姑息治疗与这些团队的整合将受到欢迎。
局限性包括从单一机构招募、受试者对姑息治疗缺乏了解以及参与者中种族和民族多样性有限。
移植肾功能逐渐下降的患者有多种未满足的姑息治疗需求，包括情绪症状和对更好预后意识的渴望。我们的结果表明，患者在很大程度上不了解姑息治疗，可能会从移植团队整合姑息治疗教育和及时开展姑息治疗的实践模式中获益。
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