Nephrology-tailored geriatric assessment as decision-making tool in kidney failure

IF 1.5 4区医学 Q3 NURSING Journal of renal care Pub Date : 2023-04-08 DOI:10.1111/jorc.12466

Noeleen C. Berkhout-Byrne RN, MSc, Carlijn G. N. Voorend MSc, Yvette Meuleman MSc, PhD, Simon P. Mooijaart MD, PhD, Anja H. Brunsveld-Reinders RN, MSc, PhD, Willem Jan W. Bos MD, PhD, Marjolijn Van Buren MD, PhD

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Abstract

Background

Dialysis might not benefit all older patients with kidney failure, particularly those with multimorbid conditions and frailty. Patients' and healthcare professionals' awareness of the presence of geriatric impairments could improve outcomes by tailoring treatment plans and decisions for individual patients.

Objective

We aimed to explore the perspectives of patients and healthcare professionals on nephrology-tailored geriatric assessment to fuel decision-making for treatment choices in older patients with kidney failure.

Design

In an exploratory qualitative study using focus groups, participants discussed perspectives on the use and value of nephrology-tailored geriatric assessment for the decision-making process to start or forego dialysis.

Participants and Measurements

Patients (n = 18) with kidney failure, caregivers (n = 4), and professionals (n = 25) were purposively sampled from 10 hospitals. Interviews were audio-recorded, transcribed verbatim and inductively analysed using thematic analysis.

Results

Three main themes emerged that supported or impeded decision-making in kidney failure: (1) patient psycho-social situation; (2) patient-related factors on modality choice; (3) organisation of health care. Patients reported feeling vulnerable due to multiple chronic conditions, old age, experienced losses in life and their willingness to trade longevity for quality of life. Professionals recognised the added value of nephrology-tailored geriatric assessment in three major themes: (i) facilitating continual holistic assessment, (ii) filling the knowledge gap, and (iii) uncovering important patient characteristics.

Conclusions

nephrology-tailored geriatric assessment was perceived as a valuable tool to identify geriatric impairments in older patients with kidney failure. Integration of its outcomes can facilitate a more holistic approach to inform choices and decisions about kidney replacement therapy.

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肾病学定制的老年病学评估作为肾衰竭的决策工具。

背景：透析可能无法惠及所有老年肾衰竭患者，尤其是那些患有多病和体弱的患者。患者和医护人员对老年病障碍的认识可为患者量身定制治疗方案和决定，从而改善治疗效果：我们旨在探讨患者和医护人员对肾病学定制老年病学评估的看法，以帮助老年肾衰竭患者做出治疗选择决策：设计：在一项采用焦点小组的探索性定性研究中，参与者讨论了在开始或放弃透析的决策过程中，肾病学定制的老年病学评估的使用和价值：从 10 家医院有针对性地抽取了肾衰竭患者（18 人）、护理人员（4 人）和专业人员（25 人）。对访谈进行录音、逐字记录，并采用主题分析法进行归纳分析：结果：支持或阻碍肾衰竭患者决策的三大主题分别是：（1）患者的社会心理状况；（2）患者选择治疗方式的相关因素；（3）医疗机构的组织结构。患者表示，由于患有多种慢性疾病、年事已高、经历过生命损失以及愿意用寿命来换取生活质量，他们感到非常脆弱。专业人士认为肾脏病学定制的老年病学评估在三个主要方面具有附加价值：（i）促进持续的整体评估；（ii）填补知识空白；（iii）发现重要的患者特征。整合评估结果有助于采取更全面的方法，为肾脏替代疗法的选择和决策提供依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of renal care Nursing-Advanced and Specialized Nursing

CiteScore

3.50

自引率

5.30%

发文量

期刊介绍： The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.

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