Consider - considerations of nephrologists when suggesting dialysis in elderly patients with renal failure

a discrete choice experiment

Celine Foote, Rachael L. Morton, Meg Jardine, M. Gallagher, M Brown, Kirsten Howard, Alan Cass

    Research output: Contribution to journalMeeting AbstractResearch

    Abstract

    Aim: Determine the relative influence of elderly patient characteristics on nephrologists' dialysis recommendations.


    Background: Nephrologists often face difficult decisions in recommending dialysis or non‐dialysis (supportive) care for elderly patients, given uncertainty around survival and the heavy burden of dialysis treatment. Discrete choice experiments (DCEs) mimic real‐world decisions through simultaneous consideration of multiple variables.


    Methods: We conducted a DCE among Australasian nephrologists to assess the influence of patient characteristics on preferences for recommending dialysis. The DCE consisted of 12 scenarios of two patients described in terms of age, gender, cognition, comorbidity, life expectancy, current quality of life (QOL), expected QOL with dialysis, social support, patient and family inclination. Nephrologists indicated which hypothetical patient they preferred recommending dialysis for, or whether they preferred “neither”. Mixed logit models determined the odds of recommending dialysis over no dialysis. Trade‐offs between QOL and survival were calculated.


    Results: A total of 159 nephrologists participated, with 34% aged 40–49 years, 62% male and 69% Caucasian. All characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (OR 68.3 (95%CI 33.4–140.0)), lower comorbidity (OR 2.1 (1.1–4.1)), increased life expectancy (OR 2.8 (2.1–3.7)), high current QOL (OR 2.8 (2.0–3.8)) and positive patient and family dialysis inclination ((OR 27.5 (16.2–46.8), (OR 2.0 (1.3–3.3)) respectively). Nephrologists aged >65 were more likely (OR 11.7 (1.8–77.2)) to recommend dialysis. Nephrologists were willing to forgo 12 months of survival to avoid substantial QOL decrease with dialysis initiation.


    Conclusions:
     Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform dialysis decisions for the elderly, systematic and longitudinal evaluations of cognition and QOL are needed and research to better understand patient preferences.

    Original languageEnglish
    Article number138
    Pages (from-to)54-54
    Number of pages1
    JournalNephrology
    Volume19
    Issue numberS4
    DOIs
    Publication statusPublished - Aug 2014

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    Renal Insufficiency
    Dialysis
    Cognition
    Nephrologists
    Survival
    Comorbidity
    Life Expectancy
    Social Support
    Patient Care

    Cite this

    Foote, Celine ; Morton, Rachael L. ; Jardine, Meg ; Gallagher, M. ; Brown, M ; Howard, Kirsten ; Cass, Alan. / Consider - considerations of nephrologists when suggesting dialysis in elderly patients with renal failure : a discrete choice experiment. In: Nephrology. 2014 ; Vol. 19, No. S4. pp. 54-54.
    @article{8bb2461be3e8409292609ca7a584d46e,
    title = "Consider - considerations of nephrologists when suggesting dialysis in elderly patients with renal failure: a discrete choice experiment",
    abstract = "Aim: Determine the relative influence of elderly patient characteristics on nephrologists' dialysis recommendations. Background: Nephrologists often face difficult decisions in recommending dialysis or non‐dialysis (supportive) care for elderly patients, given uncertainty around survival and the heavy burden of dialysis treatment. Discrete choice experiments (DCEs) mimic real‐world decisions through simultaneous consideration of multiple variables. Methods: We conducted a DCE among Australasian nephrologists to assess the influence of patient characteristics on preferences for recommending dialysis. The DCE consisted of 12 scenarios of two patients described in terms of age, gender, cognition, comorbidity, life expectancy, current quality of life (QOL), expected QOL with dialysis, social support, patient and family inclination. Nephrologists indicated which hypothetical patient they preferred recommending dialysis for, or whether they preferred “neither”. Mixed logit models determined the odds of recommending dialysis over no dialysis. Trade‐offs between QOL and survival were calculated. Results: A total of 159 nephrologists participated, with 34{\%} aged 40–49 years, 62{\%} male and 69{\%} Caucasian. All characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (OR 68.3 (95{\%}CI 33.4–140.0)), lower comorbidity (OR 2.1 (1.1–4.1)), increased life expectancy (OR 2.8 (2.1–3.7)), high current QOL (OR 2.8 (2.0–3.8)) and positive patient and family dialysis inclination ((OR 27.5 (16.2–46.8), (OR 2.0 (1.3–3.3)) respectively). Nephrologists aged >65 were more likely (OR 11.7 (1.8–77.2)) to recommend dialysis. Nephrologists were willing to forgo 12 months of survival to avoid substantial QOL decrease with dialysis initiation. Conclusions: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform dialysis decisions for the elderly, systematic and longitudinal evaluations of cognition and QOL are needed and research to better understand patient preferences.",
    author = "Celine Foote and Morton, {Rachael L.} and Meg Jardine and M. Gallagher and M Brown and Kirsten Howard and Alan Cass",
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    Consider - considerations of nephrologists when suggesting dialysis in elderly patients with renal failure : a discrete choice experiment. / Foote, Celine; Morton, Rachael L.; Jardine, Meg; Gallagher, M.; Brown, M; Howard, Kirsten; Cass, Alan.

    In: Nephrology, Vol. 19, No. S4, 138, 08.2014, p. 54-54.

    Research output: Contribution to journalMeeting AbstractResearch

    TY - JOUR

    T1 - Consider - considerations of nephrologists when suggesting dialysis in elderly patients with renal failure

    T2 - a discrete choice experiment

    AU - Foote, Celine

    AU - Morton, Rachael L.

    AU - Jardine, Meg

    AU - Gallagher, M.

    AU - Brown, M

    AU - Howard, Kirsten

    AU - Cass, Alan

    PY - 2014/8

    Y1 - 2014/8

    N2 - Aim: Determine the relative influence of elderly patient characteristics on nephrologists' dialysis recommendations. Background: Nephrologists often face difficult decisions in recommending dialysis or non‐dialysis (supportive) care for elderly patients, given uncertainty around survival and the heavy burden of dialysis treatment. Discrete choice experiments (DCEs) mimic real‐world decisions through simultaneous consideration of multiple variables. Methods: We conducted a DCE among Australasian nephrologists to assess the influence of patient characteristics on preferences for recommending dialysis. The DCE consisted of 12 scenarios of two patients described in terms of age, gender, cognition, comorbidity, life expectancy, current quality of life (QOL), expected QOL with dialysis, social support, patient and family inclination. Nephrologists indicated which hypothetical patient they preferred recommending dialysis for, or whether they preferred “neither”. Mixed logit models determined the odds of recommending dialysis over no dialysis. Trade‐offs between QOL and survival were calculated. Results: A total of 159 nephrologists participated, with 34% aged 40–49 years, 62% male and 69% Caucasian. All characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (OR 68.3 (95%CI 33.4–140.0)), lower comorbidity (OR 2.1 (1.1–4.1)), increased life expectancy (OR 2.8 (2.1–3.7)), high current QOL (OR 2.8 (2.0–3.8)) and positive patient and family dialysis inclination ((OR 27.5 (16.2–46.8), (OR 2.0 (1.3–3.3)) respectively). Nephrologists aged >65 were more likely (OR 11.7 (1.8–77.2)) to recommend dialysis. Nephrologists were willing to forgo 12 months of survival to avoid substantial QOL decrease with dialysis initiation. Conclusions: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform dialysis decisions for the elderly, systematic and longitudinal evaluations of cognition and QOL are needed and research to better understand patient preferences.

    AB - Aim: Determine the relative influence of elderly patient characteristics on nephrologists' dialysis recommendations. Background: Nephrologists often face difficult decisions in recommending dialysis or non‐dialysis (supportive) care for elderly patients, given uncertainty around survival and the heavy burden of dialysis treatment. Discrete choice experiments (DCEs) mimic real‐world decisions through simultaneous consideration of multiple variables. Methods: We conducted a DCE among Australasian nephrologists to assess the influence of patient characteristics on preferences for recommending dialysis. The DCE consisted of 12 scenarios of two patients described in terms of age, gender, cognition, comorbidity, life expectancy, current quality of life (QOL), expected QOL with dialysis, social support, patient and family inclination. Nephrologists indicated which hypothetical patient they preferred recommending dialysis for, or whether they preferred “neither”. Mixed logit models determined the odds of recommending dialysis over no dialysis. Trade‐offs between QOL and survival were calculated. Results: A total of 159 nephrologists participated, with 34% aged 40–49 years, 62% male and 69% Caucasian. All characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (OR 68.3 (95%CI 33.4–140.0)), lower comorbidity (OR 2.1 (1.1–4.1)), increased life expectancy (OR 2.8 (2.1–3.7)), high current QOL (OR 2.8 (2.0–3.8)) and positive patient and family dialysis inclination ((OR 27.5 (16.2–46.8), (OR 2.0 (1.3–3.3)) respectively). Nephrologists aged >65 were more likely (OR 11.7 (1.8–77.2)) to recommend dialysis. Nephrologists were willing to forgo 12 months of survival to avoid substantial QOL decrease with dialysis initiation. Conclusions: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform dialysis decisions for the elderly, systematic and longitudinal evaluations of cognition and QOL are needed and research to better understand patient preferences.

    U2 - 10.1111/nep.12301

    DO - 10.1111/nep.12301

    M3 - Meeting Abstract

    VL - 19

    SP - 54

    EP - 54

    JO - Nephrology

    JF - Nephrology

    SN - 1320-5358

    IS - S4

    M1 - 138

    ER -