Interdisciplinary Care for Geriatric Syndromes in CKD: A Qualitative Study

Abstract

Key Points:

1. Addressing geriatric syndromes in CKD likely requires implementation of an interdisciplinary model of care.

2. Experts shared multilevel barriers to implementation of this model and strategies to mitigate each barrier.

3. Experts felt that patient satisfaction and clinician burnout could improve with implementing interdisciplinary care in CKD.

Background: Despite their prevalence, prognostic significance, and prioritization by patients, key geriatric syndromes, such as cognitive impairment, frailty, and depression, are not routinely addressed in CKD care in the United States (US). In an interdisciplinary care model, health professionals with diverse expertise collaborate to address all symptoms and functional impairments occurring alongside a patient's chronic disease. Thus, routinely addressing geriatric syndromes in CKD may require implementing this evidence-based model of care and adapting it to the needs of patients with CKD. In a formative step to understanding how health systems could implement an interdisciplinary model of care to address geriatric syndromes in CKD, we interviewed health professionals around the world with relevant expertise.

Methods: We conducted a qualitative study informed by the Consolidated Framework for Implementation Research. We interviewed nephrologists, administrators, geriatricians, palliative medicine specialists, subspecialists, and allied health professionals working in other interdisciplinary clinics from the United States, United Kingdom, India, and Canada. We analyzed results using an inductive-deductive approach.

Results: Thematic saturation occurred at 42 experts. Three major domains emerged: barriers to implementation, strategies to mitigate barriers, and benefits of implementation. Barriers were categorized into overarching themes related to (1) aging-friendly policy and workforce availability, (2) organizational culture and structure, and (3) nephrologist and patient perceptions. Strategies to mitigate barriers were categorized into themes related to (1) demonstrating viability, (2) facilitating effective health communication, (3) soliciting support from administrators and clinicians, and (4) expanding the base for patient information and treatment evidence. Proposed benefits of implementation included improved shared decision making and reduced nephrologist burnout.

Conclusions: Implementing an interdisciplinary model of care that addresses geriatric syndromes in CKD is possible but will require overcoming policy-related, financial, cultural, and structural barriers. Such a model of care may ultimately benefit patients and nephrologists.

Keywords: geriatric nephrology; patient-centered care.