Medical Record Documentation of Goals-of-Care Discussions Among Older Veterans With Incident Kidney Failure.
Medical Record Documentation of Goals-of-Care Discussions Among Older Veterans With Incident Kidney Failure.
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DOI：
10.1053/j.ajkd.2019.07.024
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发表时间：
2020-05
期刊：
影响因子：
--
通讯作者：
Kurella Tamura M
中科院分区：
文献类型：
--
作者：
Bradshaw CL;Gale RC;Chettiar A;Ghaus SJ;Thomas IC;Fung E;Lorenz K;Asch SM;Anand S;Kurella Tamura M
患者偏好的启发和记录是共同决策的核心，在预期死亡率高的患者中尤为重要。发生肾衰竭的老年患者与其提供者进行此类讨论的程度尚不清楚，其特征是本研究的重点。回顾性队列研究。随机抽取2005年至2010年期间接受美国退伍军人健康管理局护理的67岁及以上肾衰竭患者。人口统计学和设施特征，以及透析开始后预测的6个月死亡风险和复苏偏好记录。记录透析治疗和支持性护理的讨论。我们回顾了肾衰竭事件发生前2年和发生后1年的医疗记录，以确定关于透析治疗、支持性护理和复苏的记录讨论的频率和时间。逻辑回归用于识别与这些记录的讨论相关的因素。821名退伍军人的队列平均年龄为80.9 ± 7.2岁，37.2%的患者透析后6个月的预测死亡风险> 20%。分别有55.6%和77.1%的患者记录了关于透析治疗和复苏的讨论。32.4%的人提供支持性治疗。记录的频率因死亡风险和患者最终是否开始透析而异。在校正分析中，记录的频率和模式与地理位置和接受门诊肾病治疗的相关性比与患者人口统计学或临床特征的相关性更强。文件可能不能完全反映讨论的质量和内容，并且对非退伍军人患者的可推广性有限。在发生肾衰竭的老年退伍军人中，透析治疗的讨论与预先护理计划的其他方面无关，即使在死亡率高的患者中也是如此。
Elicitation and documentation of patient preferences is at the core of shared decision making and is particularly important among patients with high anticipated mortality. The extent to which older patients with incident kidney failure undertake such discussions with their providers is unknown and its characterization was the focus of this study. Retrospective cohort study. A random sample of veterans 67 years and older with incident kidney failure receiving care from the US Veterans Health Administration between 2005 and 2010. Demographic and facility characteristics, as well as predicted 6-month mortality risk after dialysis initiation and documentation of resuscitation preferences. Documented discussions of dialysis treatment and supportive care. We reviewed medical records over the 2 years before incident kidney failure and up to 1 year afterward to ascertain the frequency and timing of documented discussions about dialysis treatment, supportive care, and resuscitation. Logistic regression was used to identify factors associated with these documented discussions. The cohort of 821 veterans had a mean age of 80.9 ± 7.2 years, and 37.2% had a predicted 6-month mortality risk > 20% with dialysis. Documented discussions addressing dialysis treatment and resuscitation were present in 55.6% and 77.1% of patients, respectively. Those addressing supportive care were present in 32.4%. The frequency of documentation varied by mortality risk and whether the patient ultimately started dialysis. In adjusted analyses, the frequency and pattern of documentation were more strongly associated with geographic location and receipt of outpatient nephrology care than with patient demographic or clinical characteristics. Documentation may not fully reflect the quality and content of discussions, and generalizability to nonveteran patients is limited. Among older veterans with incident kidney failure, discussions of dialysis treatment are decoupled from other aspects of advance care planning and are suboptimally documented, even among patients at high risk for mortality.
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DOI：
10.1053/j.ajkd.2017.11.011
发表时间：
2018-05
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Ladin K;Pandya R;Kannam A;Loke R;Oskoui T;Perrone RD;Meyer KB;Weiner DE;Wong JB
通讯作者：
Wong JB
DOI：
10.2215/cjn.03860609
发表时间：
2010-01-01
影响因子：
9.8
作者：
Cohen, Lewis M.;Ruthazer, Robin;Germain, Michael J.
通讯作者：
Germain, Michael J.
DOI：
10.2215/cjn.05960809
发表时间：
2010-02-01
影响因子：
9.8
作者：
Davison, Sara N.
通讯作者：
Davison, Sara N.
DOI：
10.2215/cjn.11351015
发表时间：
2016-05-06
影响因子：
9.8
作者：
O'Hare, Ann M.;Szarka, Jackie;Vig, Elizabeth K.
通讯作者：
Vig, Elizabeth K.
影响因子：
6.1
作者：
Song, Mi-Kyung;Lin, Feng-Chang;Ward, Sandra E.
通讯作者：
Ward, Sandra E.