Little is known about perceptions of conservative care for patients with advanced chronic kidney disease (CKD) in the United States.
Qualitative study using cognitive interviewing about attitudes regarding conservative care using decision aids on treatments for advanced CKD developed outside the United States.
14 patients aged ≥75 years with advanced CKD, defined as an eGFR ≤20 ml/min/1.73m2 and not receiving maintenance dialysis, and 6 of their family members.
Thematic analysis of participants’ reactions to descriptions of conservative care taken from a various clinical care decision aids.
Participants were mostly white (n=15) and had at least some college education (n=16). Four themes emerged from analysis of interviews: 1) Core elements of conservative care: aspects of conservative care that were appealing to participants included a whole-person, team-based and structured approach to care that focused on symptom management, maintaining current lifestyle and managing health setbacks; 2) Importance of how conservative care is framed: participants were more receptive to conservative care when this was framed as an active rather than passive treatment approach and were willing to tolerate uncertainty about future course of illness and prognosis; 3) An explicit approach to shared decision-making: participants believed decisions about conservative care and dialysis should address considerations about risk and benefits of treatment options, family and clinician perspectives and patients’ goals, values and preferences; and, 4) Relationship between conservative care and dialysis: although conservative care models outside the US are generally intended to serve as an alternative to dialysis, participants’ comments implied that they did not see conservative care and dialysis as mutually exclusive.
Themes identified may not generalize to the broader population of US patients with advanced CKD and their family members.
Participants were favorably disposed to a whole-person, multidisciplinary approach to conservative care especially when framed as an active treatment approach. Models of conservative care excluding the possibility of dialysis were less embraced suggesting that current models will require adaptation to meet the needs of US patients and their families.
Copyright © 2020. Published by Elsevier Inc.