Clinical journal of the American Society of Nephrology : CJASN · 2025
Prognostic Preferences of Older Adults on Maintenance Hemodialysis and Their Care Partners: A Qualitative Study.
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Liu Annie, Reich Amanda, Kalim Sahir, Roberts Jane E, Nava-Coulter Brett, El-Jawahri Areej, Ufere Nneka N, Lakin Joshua R
Аннотация
KEY POINTS: Older adults on hemodialysis often avoided time-based prognostic estimates, while care partners sought diverse types of prognostic information. Both patients and their care partners exhibited dynamic shifts in prognostic communication preferences throughout the interviews. There is a need for interprofessional, longitudinal communication interventions to address the dynamic shifts in prognostic preferences.
BACKGROUND: Although nephrology clinicians report difficulty in discussing prognostic information, patient and care partner (CP) dyadic-level preferences for prognostic information have not been well explored. Integrating dynamic and uncertain prognostic information is essential to fostering a shared understanding for serious illness conversations, especially for older adults with ESKD.
METHODS: We conducted a qualitative study of older adults with ESKD and their CPs between April and August 2024. Using thematic analysis, we identified emergent themes reflecting the perspectives and lived experiences related to prognostic information preferences of older adults on maintenance hemodialysis and their CPs.
RESULTS: We interviewed 24 participants, of whom 15 were older adults (mean age, 74.1 years [SD 6], 8 [53%] men) with ESKD on maintenance hemodialysis and nine CPs (mean age, 58.1 years [SD 12], 2 [22%] men). Five key themes emerged regarding prognostic information. First, most patients avoided prognostic information, especially time-based prognoses. Second, CPs desired a broader range of prognostic information. Third, both patients and CPs had dynamic shifts in their views on prognosis during the course of the interviews. Fourth, differing prognostic information concepts within patient-CP dyads, and fifth, spirituality, family, and dialysis staff were sources of strength for patients in integrating prognostic information.
CONCLUSIONS: Differing and dynamic needs for prognostic information by patients and CPs highlight the need for flexible, longitudinal communication interventions that can follow these evolving preferences. It is important for clinicians to ensure that shared information aligns with the uncertainty of preparing for the future while living with ESKD.
BACKGROUND: Although nephrology clinicians report difficulty in discussing prognostic information, patient and care partner (CP) dyadic-level preferences for prognostic information have not been well explored. Integrating dynamic and uncertain prognostic information is essential to fostering a shared understanding for serious illness conversations, especially for older adults with ESKD.
METHODS: We conducted a qualitative study of older adults with ESKD and their CPs between April and August 2024. Using thematic analysis, we identified emergent themes reflecting the perspectives and lived experiences related to prognostic information preferences of older adults on maintenance hemodialysis and their CPs.
RESULTS: We interviewed 24 participants, of whom 15 were older adults (mean age, 74.1 years [SD 6], 8 [53%] men) with ESKD on maintenance hemodialysis and nine CPs (mean age, 58.1 years [SD 12], 2 [22%] men). Five key themes emerged regarding prognostic information. First, most patients avoided prognostic information, especially time-based prognoses. Second, CPs desired a broader range of prognostic information. Third, both patients and CPs had dynamic shifts in their views on prognosis during the course of the interviews. Fourth, differing prognostic information concepts within patient-CP dyads, and fifth, spirituality, family, and dialysis staff were sources of strength for patients in integrating prognostic information.
CONCLUSIONS: Differing and dynamic needs for prognostic information by patients and CPs highlight the need for flexible, longitudinal communication interventions that can follow these evolving preferences. It is important for clinicians to ensure that shared information aligns with the uncertainty of preparing for the future while living with ESKD.