Many Dialysis Patients Do Not Think of Themselves As Having a Life Limiting Condition

MedicalResearch.com Interview with:

Dr. Ann M. O’Hare, MD Professor,Division of Nephrology University of Washington Investigator, VA HSR&D Center of Excellence Affiliate Investigator, Group Health Research Institute Seattle, WA 

Prof. O’Hare

Dr. Ann M. O’Hare, MD
Professor,Division of Nephrology
University of Washington
Investigator, VA HSR&D Center of Excellence
Affiliate Investigator, Group Health Research Institute
Seattle, WA

 MedicalResearch.com: What is the background for this study?

Response: We know that survival for people undergoing dialysis is generally quite limited.  Only a few studies have attempted to elicit how patients undergoing dialysis understand prognosis and how their prognostic awareness might be related to their interest in planning for the future, their preferences for resuscitation and the kind of care they would want if they were seriously ill or dying.

MedicalResearch.com: What are the main findings? 

Response: Most of the patients who participated in this study were either unsure about the life expectancy of people of their age with similar health conditions, or endorsed a life expectancy of more than ten years, which is very optimistic when viewed in the context of actual survival for US dialysis patients.

We also found that those patients with either uncertain or optimistic prognostic expectations tended to be less likely to have documented their wishes for the future and designated a surrogate decision maker and were more likely to want to be resuscitated and to prefer care focused on life prolongation. 

MedicalResearch.com: What should readers take away from your report?

Response: Many dialysis patients do not think of themselves as having a life limiting condition.  This might limit the reach of advance care planning and contribute to the aggressive patterns of end-of-life care focused on life prolongation that we see in this population. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: More work is needed to understand what factors shape patients’ expectations for the future and whether there might be ways that clinicians and health systems could do a better job cultivating prognostic awareness among members of this population so that they have at least a rough idea of what to expect in the future.  This kind of research could support interventional studies to see whether efforts to raise patients’ prognostic awareness can help to support decision-making and the delivery of care that is concordant with their goals and preferences, perhaps helping those who care for these patients to uphold their personhood–the essence of who they are–throughout the course of illness. 

MedicalResearch.com: Is there anything else you would like to add?

Response: This work was funded by the NIDDK and recruitment was supported by the University of Washington Kidney Research Institute and Dialysis Clinic, Inc. We are very grateful to these organizations and to the patients who agreed to participate in the study. 

Citation:

O’Hare AM, et al. JAMA Intern Med2019;doi:10.1001/jamainternmed.2019.2879. 

 

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