Abstract: TH-OR15
Preferences for End-of-Life Care Among Dialysis Patients: A Discrete Choice Experiment
Session Information
- Dialysis: Patient-Centered Interventions and Outcomes
November 03, 2022 | Location: W414, Orange County Convention Center‚ West Building
Abstract Time: 05:06 PM - 05:15 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Filus, Ania, Davita Clinical Research, Minneapolis, Minnesota, United States
- Harmeyer, Katie T., Davita Clinical Research, Minneapolis, Minnesota, United States
- Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
- Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States
Background
Given the high symptom and morbidity burden related to kidney failure, there is an urgent need to deliver care that aligns with patient wishes and priorities at each stage of their disease, including as they approach End of life (EoL). However, there is a knowledge gap of patients’ specific preferences for their EoL care. We leveraged a discrete choice experiment approach to identify factors that are important to dialysis patients.
Methods
In August-September 2021, we deployed an online survey that assessed the importance of the three aspects of EoL care: degree of pain management (well vs. poorly controlled), frequency of hospitalizations (sometimes vs. often), and place of death (home vs. hospital). We utilized a block fraction factorial design with 2 blocks and 4 questions within each block (Figure 1). Patients were asked to choose between two alternative scenarios of EoL care for each question.
Results
Surveys were collected from 796 patients, including home dialysis (2.2%) and in-center (97.8%) dialysis patients. The median age was 54 years and 40% were female. The race composition was 37% White, 35% Black, 16% Hispanic, and 5% Asian. The majority of surveyed patients (70%) reported being on dialysis from 1 to 7 years and most rated their subjective health as average (49%) or better (33%) than other dialysis patients. Results from the discrete choice experiment indicate that patients were 3.7 times more likely to choose a scenario with well-managed pain over poor pain management. The frequency of hospital visits [OR 1.3 (95% CI 1.21-1.47)] at the EoL was the least important attribute of quality of care at the end of life (Table 1). Patients were 1.5 times more likely to choose dying at home vs the hospital.
Conclusion
The level of pain management was the most important attribute of quality of care at the end of life, over frequency of hospital visits and place of death.
| Coefficient | Odds Ratio | SE (Coefficient) | Statistical Significance | |
| Well managed pain vs. not well managed pain | 1.31 | 3.7 | 0.05 | p<0.001 |
| Occasional hospitalization vs. frequent hospitalization | 0.29 | 1.3 | 0.05 | p<0.001 |
| Dying at home vs. dying in the hospital | 0.40 | 1.5 | 0.05 | p<0.001 |