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. 2023 Jun 1;4(6):e751-e758.
doi: 10.34067/KID.0000000000000131. Epub 2023 May 5.

Prevalence and Correlates of Preference-Concordant Care Among Hospitalized People Receiving Maintenance Dialysis

Basil S Kazi  1   2 , Paul R Duberstein  3 , Benzi M Kluger  4   5 , Ronald M Epstein  4   6 , Kevin A Fiscella  6   7 , Zain S Kazi  8 , Spencer K Dahl  2 , Rebecca J Allen  9 , Fahad Saeed  7   10
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Prevalence and Correlates of Preference-Concordant Care Among Hospitalized People Receiving Maintenance Dialysis

Basil S Kazi et al. Kidney360. .

Abstract

Key Points:

  1. A large proportion of hospitalized patients receiving dialysis report not receiving preference-concordant care.

  2. Hospitalized patients on dialysis desiring a comfort-oriented medical plan were likely to report receiving preference-concordant care.

Background: Preference-concordant care is a cornerstone of high-quality medical decision-making, yet the prevalence and correlates of preference-concordant care have not been well-studied in patients receiving dialysis. We surveyed hospitalized people receiving maintenance dialysis to estimate the prevalence and correlates of preference-concordant care among this population.

Methods: We assessed preference concordance by asking participants (223/380, 59% response rate), “How strongly do you agree or disagree that your current treatment plan meets your preference?” We assessed treatment plan preference by asking whether patients preferred a plan that focused on (1) extending life or (2) relieving pain and discomfort. We assessed shared dialysis decision-making using the 9-item Shared Decision-Making Questionnaire. We examined the differences between those reporting lack of preference-concordant care and those reporting receipt of preference-concordant care using chi-squared analyses. We also studied whether patients' treatment plan preferences or shared dialysis decision-making scores were correlated with their likelihood of receiving preference-concordant care.

Results: Of the 213 respondents who provided data on preference concordance, 90 (42.3%) reported that they were not receiving preference-concordant care. Patients who preferred pain and discomfort relief over life extension were less likely (odds ratio, 0.15 [95% confidence interval, 0.08 to 0.28] P = <0.0001) to report receiving preference-concordant care; patients with higher shared decision-making scores were more likely (odds ratio, 1.02 [95% confidence interval, 1.01 to 1.03], P = 0.02) to report preference-concordant care.

Conclusions: A substantial proportion of this sample of hospitalized people receiving maintenance dialysis reported not receiving preference-concordant care. Efforts to improve symptom management and enhance patient engagement in dialysis decision-making may improve the patients' perceptions of receiving preference-concordant care.

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Conflict of interest statement

R.J. Allen reports the following—research funding: Ohio Third Frontier Research Grant. Z.S. Kazi reports the following—employer: Guidehouse and Red Ventures; consultancy: Guidehouse; and ownership interest: Apple and Microsoft. B.M. Kluger reports the following—research funding: PCORI, Initiating ambulatory palliative care in Center of Excellence 2021–2023, NIH (NINR) R01 NR016037, NIH (NIA) R21 AG075524, NIH (NIA) R01 AG077053, and NIH (NIA) K02 AG062745; honoraria: American Academy of Neurology, David Phinney Foundation, International Parkinson and Movement Disorders Society, and Parkinson's Foundation; patents or royalties: Elsevier; and advisory or leadership role: President, International Neuropalliative Care Society. F. Saeed reports the following—consultancy: KJT group and research funding: NIDDKK-23 and ASN career development award, Renal Research Institute. All remaining authors have nothing to disclose.

Figures

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Comment in

References

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