A published study suggested that a single-item question may help providers better understand the treatment preferences of patients with advanced chronic kidney disease and enable more effective discussions about patient goals.
“Nephrologists face multiple barriers with respect to advance care planning, namely, that patients with advanced CKD are medically complex, receive fragmented care and have uncertain trajectories,” Nicolas Awad Baddour, MD, of the department of medicine at the University of Washington, and colleagues wrote. “In addition, data on patient treatment preferences and possible advance care planning interventions are limited. Although patients have a variety of life experiences that affect their perspectives toward advance care planning, a majority prefer for providers to discuss prognosis and present multiple treatment options when faced with disease progression. However, many providers report reluctance to initiate these discussions, with fewer than 5% of nephrologists reporting a discussion of prognosis with their patients in one study.”
Researchers sought to evaluate a single-item question designed to assess patient preferences. To do this, 382 patients with stage 4 or 5 CKD (aged 60 years or older) were recruited from a nephrology clinic. Participants ranked health outcome priorities (eg, maintain independence, reduce pain, stay alive) and treatment preferences were determined through responses to the question: “If you had a serious illness, what would be most important to you?” Options included to live as long as possible (selected by 20%), to try treatments but not suffer (35%), to focus on comfort (33%) or unsure (12%). In addition, patient preferences in common end-of life scenarios (eg, cannot recognize family, kept alive by dialysis or residency in a nursing home) were considered.
After comparing patient responses between the three tools, researchers found patients’ treatment preferences were associated with their first health outcome priority and acceptability of end-of-life scenarios. For instance, maintaining independence was the first health outcome priority for 55% and 51% of patients who selected “focus on comfort” or “try treatments but do not suffer,” respectively, compared with 34% of patients who selected “live as long as possible” as their treatment preference. In addition, one third of patients who preferred to “focus on comfort” reported that a life on dialysis would not be worth living vs. 5% of those who chose “live as long as possible.”
“Importantly, the vast majority of patients were willing to share their serious illness preference with their providers and to have them documented in the EHR,” the researchers wrote. “Across specialties, goals-of-care communication between patients and providers has been shown to improve important patient and health care system outcomes. Nephrologists need tools that help to initiate conversations to elicit care preferences. The single-item serious illness treatment preference question is simple, comprehensible to patients and takes little time to collect. Further, as our results suggest, the measure provides useful insight on patient health outcome priorities and preferences regarding end-of-life treatment choices.” – by Melissa J. Webb
Disclosures: Baddour reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.