Discussions during shared decision-making in older adults with advanced renal disease: a scoping review

Abstract

Objectives: This review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.

Design: We followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.

Data sources: PubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).

Eligibility criteria for inclusion: Articles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m²); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.

Data extraction and synthesis: Two independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.

Results: 248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.

Conclusion: When discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.

Keywords: adult nephrology; adult palliative care; dialysis; end stage renal failure; epidemiology; geriatric medicine.

Figure 1

​PRISMA flowchart for study inclusion.

Figure 2

​Countries of origin and years of publication of included articles.

Figure 3

​​Information needs—themes elicited.

Figure 4

Using available information in a framework for decision-making. Adapted from Schell and Cohen and Rosansky et al. Grey text boxes: information available to guide decisions. Bold arrows: suggested steps in the frameworks. Light arrows: influences.