Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis
Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis
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DOI：
10.1001/jama.291.6.697
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发表时间：
2004-02-11
影响因子：
120.7
通讯作者：
Powe, NR
中科院分区：
文献类型：
--
作者：
Rubin, HR;Fink, NE;Powe, NR
鉴于不同的透析方式对生存有不同的影响，在选择血液透析和腹膜透析时，患者的经历成为一个更重要的考虑因素。目的比较新近开始透析的患者对血液透析和腹膜透析的满意度。从1995年10月到1998年6月，一项前瞻性队列研究对37个透析中心最近开始透析的患者进行了横断面调查，这些患者参与了终末期肾病护理健康结果选择（CHOICE）研究，这是一项全国性的多中心透析结果研究。在736例入选的意外透析患者中，656例（89%）在平均透析7周后回复了满意度问卷。主要结果测量数据收集自一份由患者和护理人员管理的问卷，包括3个总体评分和20个项目对透析护理的具体方面进行评分。结果接受腹膜透析的患者比接受血液透析的患者更有可能对透析护理总体给予优秀评价（分别为85%对56%；相对概率为1.46[95%置信区间，1.31-1.57]），并且对所评价的每个特定护理方面给予优秀评价的可能性明显更高。差异最大的3个项目是在提供的信息领域（信息项目的平均值：腹膜透析[69%优秀]vs血液透析[30%优秀]）。最小的差异是来自肾病专家的信息准确性评分，对疼痛的反应，移走的液体量，以及紧急情况下工作人员的可用性。调整患者的年龄、种族、教育程度、健康状况、婚姻状况、就业状况、离中心的距离和开始透析的时间并没有减少腹膜透析和血液透析患者之间的差异。结论开始透析数周后，腹膜透析患者对护理的评价高于血液透析患者。这些发现表明临床医生应该给患者更多关于腹膜透析选择的信息。
Context In light of conflicting evidence of differential effects of dialysis modality on survival, patient experience becomes a more important consideration in choosing between hemodialysis and peritoneal dialysis.Objective To compare patient satisfaction with hemodialysis and peritoneal dialysis in a cohort of patients who have recently begun dialysis.Design and Setting Cross-sectional survey at enrollment in a prospective inception cohort study of patients who recently started dialysis at 37 dialysis centers participating in the Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a national multicenter study of dialysis outcomes, from October 1995 to June 1998.Patients Of 736 enrolled incident dialysis patients, 656 (89%) returned a satisfaction questionnaire after an average of 7 weeks of dialysis.Main Outcome Measure Data collected from a patient-ad ministered questionnaire including 3 overall ratings and 20 items rating specific aspects of dialysis care.Results Patients receiving peritoneal dialysis were much more likely than those receiving hemodialysis to give excellent ratings of dialysis care overall (85% vs 56%, respectively; relative probability, 1.46 [95% confidence interval, 1.31-1.57]) and significantly more likely to give excellent ratings for each specific aspect of care rated. The 3 items with the greatest differences were in the domain of information provided (average of information items: peritoneal dialysis [69% excellent] vs hemodialysis [30% excellent]). The smallest differences were in ratings of accuracy of information from the nephrologist, response to pain, amount of fluid removed, and staff availability in an emergency. Adjustment for patient age, race, education, health status, marital status, employment status, distance from the center, and time since starting dialysis did not reduce the differences between peritoneal dialysis and hemodialysis patients.Conclusions After several weeks of initiating dialysis, patients receiving peritoneal dialysis rated their care higher than those receiving hemodialysis. These findings indicate that clinicians should give patients more information about the option of peritoneal dialysis.