Dialysis or Death: A Qualitative Study of Older Patients' and Their Families' Understanding of Kidney Failure Treatment Options in a US Public Hospital Setting
Dialysis or Death: A Qualitative Study of Older Patients' and Their Families' Understanding of Kidney Failure Treatment Options in a US Public Hospital Setting
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DOI：
10.1016/j.xkme.2019.04.003
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发表时间：
2019-05-01
期刊：
影响因子：
3.9
通讯作者：
Grubbs, Vanessa
中科院分区：
文献类型：
--
作者：
Karlin, Jennifer;Chesla, Catherine A.;Grubbs, Vanessa
基本原理和目标：保守治疗（不进行透析的药物治疗）可能是某些晚期慢性肾脏疾病或肾衰竭老年患者的适当治疗选择。研究设计：定性研究，采用个体半结构化访谈，研究对象为美国一家公立医院系统的65岁以上患者及其家属，分析方法：研究对象被问及对肾衰竭治疗方案的看法。访谈录音，转录，并使用迭代的方法进行分析，主题analysis.Results：在15例患者和6个家庭成员的访谈，我们确定了3个主题。参会人员：（1）不认为保守治疗是他们自己（或他们的家人）护理的可行的个人选择，（2）仅抽象地理解透析的现实，（3）认为透析是肾衰竭的唯一治疗选择，任何替代方案都是死亡。局限性：单一地点，公立医院环境。包括年龄小于75岁的患者，透析可能具有生存获益。改变了保守治疗的定义中途通过study.Conclusions：老年患者和家庭缺乏充分的了解肾衰竭的治疗方案，因此无法做出真正明智的护理决策。
Rationale & Objective: Conservative management (medical management without dialysis) may be an appropriate treatment option for some older patients with advanced chronic kidney disease or kidney failure. Patients' and family members' perspectives about conservative management in the United States have been relatively unexplored.Study Design: Qualitative study with individual semi-structured interviews.Setting & Participants: We recruited patients 65 years and older and their family members from a public hospital system in the United States.Analytical Approach: Participants were asked about perspectives of kidney failure treatment options. Interviews were audiotaped, transcribed, and analyzed using an iterative approach to thematic analysis.Results: Among 15 patient and 6 family member interviews, we identified 3 themes. Participants: (1) do not view conservative management as a viable personal option for their own (or their family members') care, (2) understand the realities of dialysis only abstractly, and (3) consider dialysis the only treatment option for kidney failure and any alternative as death.Limitations: Single site, public hospital setting. Included patients younger than 75 years for whom dialysis likely has survival benefit. Changed the definition of conservative management partway through the study.Conclusions: Older patients and family lack full understanding of kidney failure treatment options and are therefore unable to make truly informed care decisions.