COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER)

a discrete choice experiment

Celine Foote, Rachael Morton, Meg Jardine, Martin Gallagher, M Brown, Alan Cass

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Nephrologists often face difficult decisions when recommending dialysis or non-dialysis (supportive) care for elderly patients, given the uncertainty around survival and the burden of dialysis. Discrete choice experiments (DCEs) mimic real-world decisions through simultaneous consideration of multiple variables. We aimed to determine the relative influence of patient characteristics on dialysis recommendations.

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

Conclusion: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform elderly patients' dialysis decisions, systematic and longitudinal cognition and QOL evaluations are needed as well as better research into understanding patient preferences.
Original languageEnglish
Pages (from-to)2302-2309
Number of pages8
JournalNephrology Dialysis Transplantation
Volume29
DOIs
Publication statusPublished - 2014

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Renal Insufficiency
Dialysis
Quality of Life
Odds Ratio
Confidence Intervals
Cognition
Life Expectancy
Nephrologists
Survival
Comorbidity
Patient Preference
Social Support
Uncertainty
Patient Care
Logistic Models

Cite this

@article{c25a0633b7b140d081d9f479d6eb85c2,
title = "COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER): a discrete choice experiment",
abstract = "Background: Nephrologists often face difficult decisions when recommending dialysis or non-dialysis (supportive) care for elderly patients, given the uncertainty around survival and the burden of dialysis. Discrete choice experiments (DCEs) mimic real-world decisions through simultaneous consideration of multiple variables. We aimed to determine the relative influence of patient characteristics on dialysis recommendations.Methods: We conducted a DCE among Australasian nephrologists consisting 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 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 (34{\%} aged 40–49 years, 62{\%} male and 69{\%} Caucasian). All patient characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (odds ratio [OR]: 68.3; 95{\%} confidence interval [CI]: 33.4–140.0), lower comorbidity (OR: 2.1; 95{\%} CI: 1.1–4.1), increased life expectancy (OR: 2.8; 95{\%} CI: 2.1–3.7), high current QOL (OR: 2.8; 95{\%} CI: 2.0–3.8) and positive patient and family dialysis inclination (OR: 27.5; 95{\%} CI: 16.2–46.8 and OR: 2.0; 95{\%} CI: 1.3–3.3, respectively). Nephrologists aged >65 were more likely (OR: 11.7; 95{\%} CI: 1.8–77.2) to recommend dialysis. Nephrologists were willing to forgo 12 months of patient survival to avoid substantial QOL decrease with dialysis.Conclusion: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform elderly patients' dialysis decisions, systematic and longitudinal cognition and QOL evaluations are needed as well as better research into understanding patient preferences.",
author = "Celine Foote and Rachael Morton and Meg Jardine and Martin Gallagher and M Brown and Alan Cass",
year = "2014",
doi = "10.1093/ndt/gfu257",
language = "English",
volume = "29",
pages = "2302--2309",
journal = "Nephrology Dialysis Transplantation",
issn = "0931-0509",
publisher = "Oxford University Press",

}

COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER) : a discrete choice experiment. / Foote, Celine; Morton, Rachael; Jardine, Meg; Gallagher, Martin; Brown, M; Cass, Alan.

In: Nephrology Dialysis Transplantation, Vol. 29, 2014, p. 2302-2309.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER)

T2 - a discrete choice experiment

AU - Foote, Celine

AU - Morton, Rachael

AU - Jardine, Meg

AU - Gallagher, Martin

AU - Brown, M

AU - Cass, Alan

PY - 2014

Y1 - 2014

N2 - Background: Nephrologists often face difficult decisions when recommending dialysis or non-dialysis (supportive) care for elderly patients, given the uncertainty around survival and the burden of dialysis. Discrete choice experiments (DCEs) mimic real-world decisions through simultaneous consideration of multiple variables. We aimed to determine the relative influence of patient characteristics on dialysis recommendations.Methods: We conducted a DCE among Australasian nephrologists consisting 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 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 (34% aged 40–49 years, 62% male and 69% Caucasian). All patient characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (odds ratio [OR]: 68.3; 95% confidence interval [CI]: 33.4–140.0), lower comorbidity (OR: 2.1; 95% CI: 1.1–4.1), increased life expectancy (OR: 2.8; 95% CI: 2.1–3.7), high current QOL (OR: 2.8; 95% CI: 2.0–3.8) and positive patient and family dialysis inclination (OR: 27.5; 95% CI: 16.2–46.8 and OR: 2.0; 95% CI: 1.3–3.3, respectively). Nephrologists aged >65 were more likely (OR: 11.7; 95% CI: 1.8–77.2) to recommend dialysis. Nephrologists were willing to forgo 12 months of patient survival to avoid substantial QOL decrease with dialysis.Conclusion: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform elderly patients' dialysis decisions, systematic and longitudinal cognition and QOL evaluations are needed as well as better research into understanding patient preferences.

AB - Background: Nephrologists often face difficult decisions when recommending dialysis or non-dialysis (supportive) care for elderly patients, given the uncertainty around survival and the burden of dialysis. Discrete choice experiments (DCEs) mimic real-world decisions through simultaneous consideration of multiple variables. We aimed to determine the relative influence of patient characteristics on dialysis recommendations.Methods: We conducted a DCE among Australasian nephrologists consisting 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 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 (34% aged 40–49 years, 62% male and 69% Caucasian). All patient characteristics except gender significantly affected the likelihood of dialysis recommendation. Nephrologists were more likely to recommend dialysis for patients with preserved cognition (odds ratio [OR]: 68.3; 95% confidence interval [CI]: 33.4–140.0), lower comorbidity (OR: 2.1; 95% CI: 1.1–4.1), increased life expectancy (OR: 2.8; 95% CI: 2.1–3.7), high current QOL (OR: 2.8; 95% CI: 2.0–3.8) and positive patient and family dialysis inclination (OR: 27.5; 95% CI: 16.2–46.8 and OR: 2.0; 95% CI: 1.3–3.3, respectively). Nephrologists aged >65 were more likely (OR: 11.7; 95% CI: 1.8–77.2) to recommend dialysis. Nephrologists were willing to forgo 12 months of patient survival to avoid substantial QOL decrease with dialysis.Conclusion: Nephrologists avoided dialysis recommendation if it was expected to considerably reduce QOL. To inform elderly patients' dialysis decisions, systematic and longitudinal cognition and QOL evaluations are needed as well as better research into understanding patient preferences.

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U2 - 10.1093/ndt/gfu257

DO - 10.1093/ndt/gfu257

M3 - Article

VL - 29

SP - 2302

EP - 2309

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

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