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 language | English |
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Article number | 138 |
Pages (from-to) | 54-54 |
Number of pages | 1 |
Journal | Nephrology |
Volume | 19 |
Issue number | S4 |
DOIs | |
Publication status | Published - Aug 2014 |