Serious Illness Treatment Preferences for Older Adults with Advanced CKD

Abstract

Background: Patient-centered care for older adults with CKD requires communication about patient's values, goals of care, and treatment preferences. Eliciting this information requires tools that patients understand and that enable effective communication about their care preferences.

Methods: Nephrology clinic patients age ≥60 years with stage 4 or 5 nondialysis-dependent CKD selected one of four responses to the question, "If you had a serious illness, what would be important to you?" Condensed versions of the options were, "Live as long as possible;" "Try treatments, but do not suffer;" "Focus on comfort;" or "Unsure." Patients also completed a validated health outcome prioritization tool and an instrument determining the acceptability of end-of-life scenarios. Patient responses to the three tools were compared.

Results: Of the 382 participants, 35% (n=134) selected "Try treatments, but do not suffer;" 33% (n=126) chose "Focus on comfort;" 20% (n=75) opted for "Live as long as possible;" and 12% (n=47) selected "Unsure." Answers were associated with patients' first health outcome priority and acceptability of end-of-life scenarios. One third of patients with a preference to "Focus on comfort" reported that a life on dialysis would not be worth living compared with 5% of those who chose "Live as long as possible" (P<0.001). About 90% of patients agreed to share their preferences with their providers.

Conclusions: Older adults with advanced CKD have diverse treatment preferences and want to share them. A single treatment preference question correlated well with longer, validated health preference tools and may provide a point of entry for discussions about patient's treatment goals.

Keywords: advance care planning; end of life; goals of care; health outcome priority; serious illness.

Graphical abstract

Figure 1.

Study flow diagram.

Figure 2.

Patients’ first health outcome priority by serious illness treatment preference. *chi-squared P<0.001.

Figure 3.

Serious illness treatment preference and the acceptability of being kept alive by chronic dialysis. *“Focus on comfort” versus “Live as long as possible,” P<0.001; “Focus on comfort” versus “Try treatments, but do not suffer,” P=0.005; “Live as long as possible” versus “Try treatments, but do not suffer,” P=0.01.