Opportunities to Improve Shared Decision Making in Dialysis Decisions for Older Adults with Life-Limiting Kidney Disease: A Pilot Study Article Swipe
Christopher J. Zimmermann
,
R. Allan Jhagroo
,
Maureen Wakeen
,
Kathryn Schueller
,
Amy Zelenski
,
Jennifer L. Tucholka
,
Daniel A. Fox
,
Nathan D. Baggett
,
Anne Buffington
,
Toby C. Campbell
,
Sara K. Johnson
,
Margaret L. Schwarze
·
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1089/jpm.2019.0340
YOU?
·
· 2020
· Open Access
·
· DOI: https://doi.org/10.1089/jpm.2019.0340
Background: Lack of awareness about the life-limiting nature of renal failure is a significant barrier to palliative care for older adults with end-stage renal disease. Objective: To train nephrologists to use the best case/worst case (BC/WC) communication tool to improve shared decision making about dialysis initiation for older patients with limited life expectancy. Design: This is a pre-/postinterventional pilot study. Setting/Subjects: There were 16 nephrologists and 30 patients of age 70 years and older with estimated glomerular filtration rate (eGFR) 2 in outpatient nephrology clinics, in Madison, WI. Measurements: Performance of tool elements, content of communication about dialysis, shared decision making, acceptability of the intervention, decisions to pursue dialysis, and palliative care referrals were measured. Results: Fifteen of 16 nephrologists achieved competence performing the BC/WC tool with standardized patients, executing at least 14 of 19 items. Nine nephrologists met with 30 patients who consented to audio record their clinic visit. Before training, clinic visits focused on laboratory results and preparation for dialysis. After training, nephrologists noted that declining kidney function was "bad news," presented dialysis and "no dialysis" as treatment options, and elicited patient preferences. Observer-measured shared decision-making (OPTION 5) scores improved from a median of 20/100 (interquartile range [IQR] 15-35) before training to 58/100 (IQR 55-65). Patients whose nephrologist used the BC/WC tool were less likely to make a decision to initiate dialysis and were more likely to be referred to palliative care. Conclusions: Nephrologists can learn to use the BC/WC tool with older patients to improve shared decision making about dialysis, which may increase access to palliative care.
Related Topics
Concepts
Medicine
Interquartile range
Dialysis
Nephrology
Advance care planning
Palliative care
Kidney disease
Internal medicine
Limiting
Renal function
Intensive care medicine
Life expectancy
End stage renal disease
Disease
Emergency medicine
Nursing
Population
Mechanical engineering
Environmental health
Engineering
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1089/jpm.2019.0340
- OA Status
- green
- Cited By
- 32
- References
- 26
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W3000145018
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W3000145018Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1089/jpm.2019.0340Digital Object Identifier
- Title
-
Opportunities to Improve Shared Decision Making in Dialysis Decisions for Older Adults with Life-Limiting Kidney Disease: A Pilot StudyWork title
- Type
-
articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2020Year of publication
- Publication date
-
2020-01-13Full publication date if available
- Authors
-
Christopher J. Zimmermann, R. Allan Jhagroo, Maureen Wakeen, Kathryn Schueller, Amy Zelenski, Jennifer L. Tucholka, Daniel A. Fox, Nathan D. Baggett, Anne Buffington, Toby C. Campbell, Sara K. Johnson, Margaret L. SchwarzeList of authors in order
- Landing page
-
https://doi.org/10.1089/jpm.2019.0340Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
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https://www.ncbi.nlm.nih.gov/pmc/articles/7232635Direct OA link when available
- Concepts
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Medicine, Interquartile range, Dialysis, Nephrology, Advance care planning, Palliative care, Kidney disease, Internal medicine, Limiting, Renal function, Intensive care medicine, Life expectancy, End stage renal disease, Disease, Emergency medicine, Nursing, Population, Mechanical engineering, Environmental health, EngineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
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32Total citation count in OpenAlex
- Citations by year (recent)
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2025: 5, 2024: 7, 2023: 8, 2022: 4, 2021: 3Per-year citation counts (last 5 years)
- References (count)
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26Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.presented | 177 |
| abstract_inverted_index.referrals | 116 |
| abstract_inverted_index.training, | 155, 167 |
| abstract_inverted_index.treatment | 183 |
| abstract_inverted_index.case/worst | 33 |
| abstract_inverted_index.competence | 125 |
| abstract_inverted_index.filtration | 77 |
| abstract_inverted_index.glomerular | 76 |
| abstract_inverted_index.initiation | 45 |
| abstract_inverted_index.laboratory | 160 |
| abstract_inverted_index.nephrology | 87 |
| abstract_inverted_index.outpatient | 86 |
| abstract_inverted_index.palliative | 16, 114, 236, 262 |
| abstract_inverted_index.performing | 126 |
| abstract_inverted_index.Performance | 93 |
| abstract_inverted_index.expectancy. | 52 |
| abstract_inverted_index.preparation | 163 |
| abstract_inverted_index.significant | 13 |
| abstract_inverted_index.nephrologist | 213 |
| abstract_inverted_index.preferences. | 188 |
| abstract_inverted_index.standardized | 131 |
| abstract_inverted_index.Nephrologists | 239 |
| abstract_inverted_index.acceptability | 105 |
| abstract_inverted_index.communication | 36, 99 |
| abstract_inverted_index.intervention, | 108 |
| abstract_inverted_index.life-limiting | 6 |
| abstract_inverted_index.m<sup>2</sup> | 84 |
| abstract_inverted_index.nephrologists | 28, 64, 123, 141, 168 |
| abstract_inverted_index.(interquartile | 201 |
| abstract_inverted_index.decision-making | 191 |
| abstract_inverted_index.Observer-measured | 189 |
| abstract_inverted_index.<b><i>Design:</i></b> | 53 |
| abstract_inverted_index.<b><i>Results:</i></b> | 119 |
| abstract_inverted_index.pre-/postinterventional | 57 |
| abstract_inverted_index.<b><i>Objective:</i></b> | 25 |
| abstract_inverted_index.<b><i>Background:</i></b> | 0 |
| abstract_inverted_index.<b><i>Conclusions:</i></b> | 238 |
| abstract_inverted_index.<b><i>Measurements:</i></b> | 92 |
| abstract_inverted_index.<b><i>Setting/Subjects:</i></b> | 60 |
| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 95 |
| corresponding_author_ids | https://openalex.org/A5082794702 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 12 |
| corresponding_institution_ids | https://openalex.org/I135310074 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/16 |
| sustainable_development_goals[0].score | 0.75 |
| sustainable_development_goals[0].display_name | Peace, Justice and strong institutions |
| citation_normalized_percentile.value | 0.9316428 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |