(2156) EDUCATING OLDER PATIENTS ABOUT DIALYSIS DECISIONS: DRAWING ON AN EDUCATIONAL FRAMEWORK AND CLINICAL EXPERIENCE

摘要

Though awareness is lacking, chronic kidney disease is extremely common. In the US alone, some 30 million adults have chronic kidney disease, and 700,000 of those have end-stage or advanced kidney disease. There are three basic treatments for end-stage kidney disease: kidney transplant, dialysis, and conservative management (or management of symptoms without dialysis). Kidney transplants, though publically hailed as miracles, are not an option for older adults who also have other severe health conditions. Dialysis may statistically prolong life for the very elderly and sick; dialysis also has a severe symptom burden - and in fact, many patients often regret their decision to start dialysis. On the other hand, conservative management, which focuses on symptom management and quality of life, can be a viable option for older, frail patients. In the United States, given the complexity of treatment choices, both the Renal Physicians Association and the American Society of Nephrology have identified that patient education and shared decision making are crucial elements of patient-centered care. Yet, patient education and shared decision-making are often lacking or ineffective in dialysis decision-making. For instance, although most patients want to know their prognosis, many patients have a poor understanding of their prognosis and rate prognostic conversations with their physicians as poor. Patients also do not understand their options; even though conservative management in older adults provides a much higher quality of life than dialysis and may have a life expectancy not tremendously less than that of dialysis. In one study, only 1% of patients recalled having discussions about conservative approach as even an option.