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COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER): a discrete choice experiment

Foote, Celine, Morton, Rachael L., Jardine, Meg, Gallagher, Martin, Brown, Mark, Cass, Alan and Howard, Kirsten (2014). COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER): a discrete choice experiment. Nephrology Dialysis Transplantation,29(12):2302-2309.

Document type: Journal Article
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IRMA ID 11381xPUB20
Title COnsiderations of Nephrologists when SuggestIng Dialysis in Elderly patients with Renal failure (CONSIDER): a discrete choice experiment
Author Foote, Celine
Morton, Rachael L.
Jardine, Meg
Gallagher, Martin
Brown, Mark
Cass, Alan
Howard, Kirsten
Journal Name Nephrology Dialysis Transplantation
Publication Date 2014
Volume Number 29
Issue Number 12
ISSN 0931-0509   (check CDU catalogue open catalogue search in new window)
Start Page 2302
End Page 2309
Total Pages 8
Place of Publication United Kingdom
Publisher Oxford University Press
HERDC Category C1 - Journal Article (DIISR)
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.

Keywords decision-making
dialysis
discrete choice
elderly
nephrologist
DOI http://dx.doi.org/10.1093/ndt/gfu257   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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