Kidney Week

Abstract: SA-PO1138

Understanding the Kidney Replacement Therapy Decision-Making Journey

Session Information

• CKD: Patient-Oriented Care and Case Reports
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Prakash, Suma, University of Rochester Medical Center, Rochester, New York, United States

Suma Prakash, MD, MS

• Vangala, Spoorthy, University of Rochester Medical Center, Rochester, New York, United States

Spoorthy Vangala, MBBS, MPH

• Razvi, Kauser S., Strategic Urban Solutions Inc., Cleveland, Ohio, United States

Kauser S. Razvi

• Taylor, Matthew, University of Rochester Medical Center, Rochester, New York, United States

Matthew Taylor, MD

• Drury, Erika, University of Rochester Medical Center, Rochester, New York, United States

Erika Drury, MD

• D'Alfonso, Marcus, University of Rochester Medical Center, Rochester, New York, United States

Marcus D'Alfonso

• Oliveira, Igor, University of Rochester Medical Center, Rochester, New York, United States

Igor Oliveira, MD

• Veazie, Peter J., University of Rochester Medical Center, Rochester, New York, United States

Peter J. Veazie, PhD

• Mcintosh, Scott, University of Rochester Medical Center, Rochester, New York, United States

Scott Mcintosh, MA, PhD

Background

This study aimed to better understand kidney replacement therapy (KRT) decision-making. It is unknown whether the KRT decision-making journey is similar across chronic kidney disease (CKD) groups and when interventions would be most helpful.

Methods

A qualitative study was done using journey mapping and focus groups. Journey mapping is a technique in which a visual representation of the process experienced sequentially by the person with their corresponding emotional journey is created. It provides information on what went well and did not at particular points in the journey allowing the participant to point out what and where in the process tailored interventions would be beneficial. Individual journey maps were done in the following CKD groups: stage 4 decided on KRT option, CKD 5 decided, CKD 4/5 undecided, post-transplant CKD 4/5, and patients with underlying stage 3-5 CKD requiring unplanned hospital dialysis start. Individual journey maps were aggregated by group and reviewed in a focus group for accuracy. Two provider focus groups were done to obtain additional perspective and validation. Theme coding was used to aggregate the journey maps and analyze the focus group data.

Results

There were 40 patient participants from a single center (8 per group) and 11 provider participants from multiple institutions. An aggregate map from the post-transplant CKD group is shown in figure 1. A group specific finding from the journey map analysis was the unplanned start group has a different set of steps in their process than the other 4 groups. A common finding across groups was the shock or grief at the time nephrologists suggest the need for KRT.

Conclusion

Journey mapping provides unique information that can be used to tailor the KRT decision-making process to the above CKD groups and may be a useful technique to look at other renal processes.

Post Transplant Map

Funding

• Other NIH Support