Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease

Morton, Rachel L., Snelling, Paul, Webster, Angela C., Rose, John, Masterson, Rosemary, Johnson, David W. and Howard, Kirsten (2012) Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. Canadian Medical Association Journal, 184 5: E277-E283. doi:10.1503/cmaj.111355


Author Morton, Rachel L.
Snelling, Paul
Webster, Angela C.
Rose, John
Masterson, Rosemary
Johnson, David W.
Howard, Kirsten
Title Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease
Journal name Canadian Medical Association Journal   Check publisher's open access policy
ISSN 0008-4409
0820-3946
1488-2329
Publication date 2012-03
Sub-type Article (original research)
DOI 10.1503/cmaj.111355
Volume 184
Issue 5
Start page E277
End page E283
Total pages 7
Place of publication Ottawa ON, Canada
Publisher Canadian Medical Association
Collection year 2013
Language eng
Formatted abstract Background: For every patient with chronic kidney disease who undergoes renal-replacement therapy, there is one patient who undergoes conservative management of their disease. We aimed to determine the most important characteristics of dialysis and the trade-offs patients were willing to make in choosing dialysis instead of conservative care.

Methods:
We conducted a discrete choice experiment involving adults with stage 3-5 chronic kidney disease from eight renal clinics in Australia. We assessed the influence of treatment characteristics (life expectancy, number of visits to the hospital per week, ability to travel, time spent undergoing dialysis [i.e., time spent attached to a dialysis machine per treatment, measured in hours], time of day at which treatment occurred, availability of subsidized transport and flexibility of the treatment schedule) on patients' preferences for dialysis versus conservative care.

Results: Of 151 patients invited to participate, 105 completed our survey. Patients were more likely to choose dialysis than conservative care if dialysis involved an increased average life expectancy (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.57-2.15), if they were able to dialyse during the day or evening rather than during the day only (OR 8.95, 95% CI 4.46-17.97), and if subsidized transport was available (OR 1.55, 95% CI 1.24-1.95). Patients were less likely to choose dialysis over conservative care if an increase in the number of visits to hospital was required (OR 0.70, 95% CI 0.56-0.88) and if there were more restrictions on their ability to travel (OR = 0.47, 95%CI 0.36-0.61). Patients were willing to forgo 7 months of life expectancy to reduce the number of required visits to hospital and 15 months of life expectancy to increase their ability to travel.

Interpretation: Patients approaching endstage kidney disease are willing to trade considerable life expectancy to reduce the burden and restrictions imposed by dialysis.
Keyword Quality-of-life
Renal replacement therapy
Elderly-patients
Decision-making
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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