Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics: A comparative study

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY Hemodialysis International Pub Date : 2023-06-15 DOI:10.1111/hdi.13103

Jeanette M. Wallin, Stefan H. Jacobson, Lena Axelsson, Jenny Lindberg, Carina I. Persson, Jenny Stenberg, Agneta Wennman-Larsen

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Abstract

Introduction

The surprise question (SQ) “Would I be surprised if this patient died within the next xx months” can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics.

Methods

This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics.

Findings

Proportions of nurses and physicians responding to the SQ with “no, not surprised” was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded “no, not surprised”, within 6 (κ = 0.366, p < 0.001, 95% CI = 0.288–0.474) and 12 months (κ = 0.379, p < 0.001, 95% CI = 0.281–0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ.

Discussion

Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.

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血液透析护士和医生对意外问题的回答存在差异，重点关注患者的临床特征：一项比较研究。

引言：“如果这个病人在未来xx个月内死亡，我会感到惊讶吗？”这个令人惊讶的问题（SQ）可以被不同的职业用来预测即将结束生命的病人需要进行严重疾病对话。然而，人们对护士和医生对SQ的不同看法以及影响他们评估的因素知之甚少。目的是探讨护士和医生对血液透析患者的SQ的反应，并调查这些回答如何与患者的临床特征相关。方法：这项横断面比较研究包括361名患者，其中112名护士和15名医生对6名和12名患者的SQ做出了回应月。获得患者特征、表现状态和合并症。Cohen’s kappa用于分析护士和医生对SQ的反应中的参与者间一致性，并应用多变量逻辑回归来揭示与患者临床特征的独立相关性。调查结果：护士和医生对SQ回答“不，不惊讶”的比例在6岁和12岁时相似月。然而，对于哪一位特定的患者，护士和医生的回答是“不，不惊讶”，在6（κ = 0.366，p 讨论：护士和医生在对血液透析患者的SQ做出反应时，有不同的评价角度。这可能会加强护士和医生之间的沟通和讨论需求，以确定即将结束生命的患者对严重疾病对话的需求，从而使血液透析护理适应患者的偏好和需求。

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来源期刊

Hemodialysis International UROLOGY & NEPHROLOGY-

CiteScore

2.50

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.

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