A Qualitative Study Describing the Perspectives on Frailty and Its Management in Individuals with Kidney Failure.

KEY POINTS: The term, frailty, had unclear meaning for most participants but was commonly explained as weakness, dependence, and unmodifiable. Knowledge of frailty assessment tools and the evidence to support their prognostic utility was low among clinicians. Though patients and caregivers saw value in discussing frailty, the label of frailty was often viewed as pejorative.

BACKGROUND

Frailty is highly prevalent among individuals with kidney failure and independently associated with poor health outcomes. Identifying and managing frailty can inform prognosis and care but stakeholders' understanding of frailty and their perspectives on how to detect and manage it in routine kidney care are unknown.

METHODS

We recruited participants from four Canadian kidney programs in Alberta, Manitoba, and Nova Scotia from January 2021 to June 2023. We conducted focus groups and semistructured interviews with patients (50 years or older with dialysis-dependent or nondependent kidney failure), caregivers, allied health care professionals, and nephrologists. We used qualitative description and inductive thematic analysis to describe their perspectives.

RESULTS

Ninety-one people participated: patients (N=31), caregivers (N=8), kidney allied health care professionals (N=38), and nephrologists (N=14). We identified three themes, each with subthemes: (1) What is frailty? All groups expressed uncertainty, but frailty was commonly described as physical, visible, inevitable, and fixed; (2) discussing frailty: the value of knowing what to expect with frailty, and frailty as a difficult topic to discuss; (3) frailty assessment and management: skepticism from patients and caregivers that frailty is measurable; support from clinicians for a systematic approach to identifying frailty but a lack of knowledge on multidisciplinary roles and potential interventions. For all groups, having actionable solutions after identifying frailty was key for acceptability and successful implementation.

CONCLUSIONS

Education on the nature and potentially modifiable aspects of frailty as well as the scope and potential benefits of frailty interventions is necessary for successful implementation of frailty detection and management in kidney care.