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Providers' Experiences Discussing Care for Patients with Kidney Failure Who Forgo KRT: A National Qualitative Study
Clinical Journal of the American Society of Nephrology ( IF 8.5 ) Pub Date : 2024-07-18 , DOI: 10.2215/cjn.0000000000000522
Susan P Y Wong 1 , Julie Chotivatanapong 1 , Deborah Lee 2 , Daniel Y Lam 1 , Marieke S van Eijk 3
Clinical Journal of the American Society of Nephrology ( IF 8.5 ) Pub Date : 2024-07-18 , DOI: 10.2215/cjn.0000000000000522
Susan P Y Wong 1 , Julie Chotivatanapong 1 , Deborah Lee 2 , Daniel Y Lam 1 , Marieke S van Eijk 3
Affiliation
cation and understanding of care for patients who forgo KRT. Background Many nephrology providers express difficulty in discussing care options for patients who forgo KRT, which hampers their ability to help patients make decisions about their current and future treatment of kidney disease. Methods We conducted a qualitative study using interviews with a national sample of nephrology providers (i.e., physicians and advanced practice providers) who participated in US professional societies between July and December 2022. We performed a thematic analysis of interviews to identify emergent themes reflecting providers' experiences discussing care for patients who forgo KRT. Results There were 21 providers (age 54±13 years, female 81%, White 32%) who participated in interviews, of whom 43% were physicians and most (57%) practiced in academic settings. Three dominant themes emerged from interviews reflecting challenges to discussing the option to forgo KRT: (1) Inconsistent terminology: while providers sought to use terms to describe care for patients who forgo KRT that affirmed patients' decision, clearly conveyed that KRT would not be pursued, and were already familiar to patients and other providers, they disagreed about which terms satisfied these priorities; (2) blurred distinctions between KRT and its alternative: providers' descriptions of their care practices suggested that differences in their approaches to caring for patients who forgo KRT and those who are planning to pursue KRT could be opaque; and (3) deciphering patients' decision to forgo KRT: providers did not readily accept patients' expressed preferences to forgo KRT at face value and described using a variety of methods to assess whether patients would follow through with their decision. Conclusions Providers used different, inconsistent terms to describe care for patients who forgo KRT. They disagreed about what this care entailed and were uncertain about what patients might mean when they express not wanting to undergo KRT....
中文翻译:
提供者讨论放弃 KRT 的肾功能衰竭患者护理的经验:一项全国定性研究
阳离子和对放弃 KRT 患者的护理的理解。背景 许多肾脏病学提供者表示难以讨论放弃 KRT 患者的护理选择,这阻碍了他们帮助患者决定当前和未来肾病治疗的能力。方法 我们进行了一项定性研究,采访了 2022 年 7 月至 2022 年 12 月期间参加美国专业协会的全国肾脏病学提供者(即医生和高级实践提供者)。我们对访谈进行了主题分析,以确定反映提供者讨论对放弃 KRT 患者的护理经验的新兴主题。结果 有 21 名提供者 (年龄 54±13 岁,女性 81%,白人 32%) 参与了访谈,其中 43% 是医生,大多数 (57%) 在学术环境中执业。访谈中出现了三个主要主题,反映了讨论放弃 KRT 的选择所面临的挑战:(1) 术语不一致:虽然提供者试图使用术语来描述放弃 KRT 的患者的护理,这些术语肯定了患者的决定,清楚地传达了不会追求 KRT,并且患者和其他提供者已经熟悉,但他们对哪些术语满足这些优先事项存在分歧;(2) KRT 与其替代方案之间的区别模糊:提供者对其护理实践的描述表明,他们照顾放弃 KRT 的患者和计划接受 KRT 的患者的方法差异可能是不透明的;(3) 破译患者放弃 KRT 的决定:提供者并不轻易接受患者表达的放弃 KRT 的表面偏好,并描述了使用各种方法来评估患者是否会遵循他们的决定。 结论 提供者使用不同、不一致的术语来描述对放弃 KRT 患者的护理。他们对这种护理意味着什么存在分歧,并且不确定当患者表示不想接受 KRT 时可能意味着什么......
更新日期:2024-07-18
中文翻译:
提供者讨论放弃 KRT 的肾功能衰竭患者护理的经验:一项全国定性研究
阳离子和对放弃 KRT 患者的护理的理解。背景 许多肾脏病学提供者表示难以讨论放弃 KRT 患者的护理选择,这阻碍了他们帮助患者决定当前和未来肾病治疗的能力。方法 我们进行了一项定性研究,采访了 2022 年 7 月至 2022 年 12 月期间参加美国专业协会的全国肾脏病学提供者(即医生和高级实践提供者)。我们对访谈进行了主题分析,以确定反映提供者讨论对放弃 KRT 患者的护理经验的新兴主题。结果 有 21 名提供者 (年龄 54±13 岁,女性 81%,白人 32%) 参与了访谈,其中 43% 是医生,大多数 (57%) 在学术环境中执业。访谈中出现了三个主要主题,反映了讨论放弃 KRT 的选择所面临的挑战:(1) 术语不一致:虽然提供者试图使用术语来描述放弃 KRT 的患者的护理,这些术语肯定了患者的决定,清楚地传达了不会追求 KRT,并且患者和其他提供者已经熟悉,但他们对哪些术语满足这些优先事项存在分歧;(2) KRT 与其替代方案之间的区别模糊:提供者对其护理实践的描述表明,他们照顾放弃 KRT 的患者和计划接受 KRT 的患者的方法差异可能是不透明的;(3) 破译患者放弃 KRT 的决定:提供者并不轻易接受患者表达的放弃 KRT 的表面偏好,并描述了使用各种方法来评估患者是否会遵循他们的决定。 结论 提供者使用不同、不一致的术语来描述对放弃 KRT 患者的护理。他们对这种护理意味着什么存在分歧,并且不确定当患者表示不想接受 KRT 时可能意味着什么......