Kidney Week

Abstract: PUB572

Perspectives of Patients and Care Partners on Prognostic Discussions in CKD: A Qualitative Study

Session Information

• Publication Only

Category: CKD (Non-Dialysis)

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

Authors

• Tauh, Shivani S., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Shivani S. Tauh, MD

• Ravani, Pietro, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Pietro Ravani, MD, PhD

• Love, Shannan, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Shannan Love

• King-Shier, Kathryn M., University of Calgary Faculty of Nursing, Calgary, Alberta, Canada

Kathryn M. King-Shier, PhD, RN

• Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Robert R. Quinn, MD, PhD

• Lam, Ngan, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Ngan Lam, MD, MSc

• Liu, Ping, University of Calgary, Calgary, Alberta, Canada

Ping Liu, PhD

• Donald, Maoliosa, University of Calgary, Calgary, Alberta, Canada

Maoliosa Donald

• Elliott, Meghan J., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada

Meghan J. Elliott, MD

Background

The incidence and prevalence of chronic kidney disease (CKD) is expected to rise over the next decade. Adults with severe CKD must navigate difficult decisions related to kidney replacement therapy and the competing risk of death without kidney failure. In this qualitative study, we sought to explore the experiences of patients with CKD and their care partners related to discussions about kidney failure risks and mortality, and to elicit their preferences for discussing and using prognostic information.

Methods

We purposively sampled patients with non-dialysis-dependent CKD (eGFR <30 mL/min/1.73m²) followed in multi-disciplinary CKD clinics and their care partners in Alberta, Canada. We conducted online or telephone-based, semi-structured interviews that centered around eliciting personal experiences and responses to clinical vignettes that included risk estimates for kidney failure and mortality. Interviews were audio recorded and transcribed verbatim. Data were coded iteratively and in duplicate and analyzed through reflexive thematic analysis.

Results

We conducted interviews with 22 patients and 7 care partners. Participants emphasized the quality of communication and interactions with their healthcare team as the greatest influences on their prognostic understanding. Participants’ experiences and preferences related to prognostic discussions are elaborated across the following themes: 1) Alignment of discussion context with informational readiness (appropriate timing, setting, roles), 2) Level of directness in conveying individual risk (sensitivity, frankness, professional obligation), 3) Quality of personal and therapeutic relationships impacting preferences (reliance on trust and support structures), and 4) Perceived value and applicability of prognostic information (personalized information, utility in care planning).

Conclusion

The perceived quality of prognostic discussions among patients with CKD and their care partners was influenced by contextual factors, individual preferences, and communication styles. Strategies tailored to individuals’ readiness and the collaborative CKD care setting may improve understanding of clinical outcomes of severe CKD and use of prognostic information in treatment planning.