How strong are patients' preferences in choices between dialysis modalities and doses?
How strong are patients' preferences in choices between dialysis modalities and doses?
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DOI：
10.1053/j.ajkd.2004.06.011
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发表时间：
2004-10-01
影响因子：
13.2
通讯作者：
Powe, NR
中科院分区：
文献类型：
--
作者：
Bass, EB;Wills, S;Powe, NR
背景：透析患者对治疗的感受可能会影响他们对高剂量或不同治疗方式生存率更高的信息的反应。我们评估了透析患者对当前治疗方式与其他治疗方式的偏好程度，不同治疗方式和剂量之间的生存差异如何影响偏好，以及偏好是否因患者特征而异。方法：我们通过使用马里兰州和马萨诸塞州的透析患者样本和时间权衡技术在0（死亡）和1（完全健康）之间进行衡量，测量了当前透析治疗健康状况的偏好值以及透析方式和剂量的标准化描述。结果：我们采访了109例血液透析治疗患者，57例持续动态腹膜透析（CAPD）患者，22例连续循环腹膜透析（CCPD）患者。血液透析、CAPD和CCPD患者对当前健康状况的偏好值相似（平均值分别为0.69、0.74和0.70;P < 0 0.1），而对替代模式的偏好值较低（例如，血液透析患者对CAPD的偏好值平均值为0.55）。如果高剂量透析使生存期延长20%，超过75%的患者会选择高剂量透析而不是低剂量透析，但超过30%的患者即使使生存期延长100%也不会改变方式。与偏好值差异相关的唯一特征是抑郁，轻度至中度抑郁情绪的人的偏好较弱。结论：透析患者对目前的透析方式有强烈的偏好，并且更有可能接受更高剂量的透析，而不是转换方式来提高生存率。医生应该与患者讨论他们喜欢的治疗方式和剂量，因为患者的特点无法预测他们的偏好。
Background: How dialysis patients feel about their treatment may influence how they respond to information suggesting that survival is better with a higher dose or different treatment modality. We assessed the strength of dialysis patients' preferences for their current treatment modality versus other modalities, how differences in survival between modalities and doses could influence preferences, and whether preferences differ by patient characteristics. Methods: We measured preference values for current health on dialysis therapy and for standardized descriptions of dialysis modalities and doses by using a sample of dialysis patients in Maryland and Massachusetts and a time trade-off technique scaled between 0 (death) and 1 (perfect health). Results: We interviewed 109 patients on hemodialysis therapy, 57 patients on continuous ambulatory peritoneal dialysis (CAPD), and 22 patients on continuous cycling peritoneal dialysis (CCPD). Hemodialysis, CAPD, and CCPD patients had similar preference values for current health (mean, 0.69, 0.74, and 0.70, respectively; P > 0.1) and lower preference values for alternative modalities (eg, mean of 0.55 assigned to CAPD by hemodialysis patients). More than 75% of patients would choose a high dose over a lower dose of dialysis if it increased length of survival by 20%, but more than 30% would not switch modality, even if it increased survival by 100%. The only characteristic associated with a difference in preference values was depression, with weaker preferences among those with mild to moderate depressive mood. Conclusion: Dialysis patients have strong preferences for their current modality and are more likely to accept a higher dose of dialysis than switch modality to increase survival. Physicians should talk with patients about the modality and dose they prefer because preferences cannot be predicted by patient characteristics.