Most older people with kidney failure choose between treatment with dialysis or conservative kidney management. The preferences underlying these decisions are poorly understood. Here, we performed a choice experiment, informed by qualitative research, to examine preferences for the characteristics of dialysis and conservative management among over-65-year-olds with eGFR of 20 mls or under/min/1.73m2. Mixed logit and latent class analyses quantified the trade-offs between frequency and location of treatments, survival, and capability (the ability to do important activities), accounting for participants’ characteristics. Overall, 327 United Kingdom participants across 23 centers (median age 77 years, eGFR 14 mls/min/1.73m 2) needed 8%-59% absolute survival benefit two years after starting treatment to accept dialysis, with preferences for less frequent treatment and treatment at home. Significantly higher preferences for survival were seen amongst partnered participants (effect size 0.04, 95% confidence interval 0.02-0.06) and if better levels of capability were depicted (effect size 0.02, 0.01-0.03). Three latent classes were identified with divergent preferences for survival, capability, and location of care. Stated preferences indicated participants favored higher survival probabilities, but only if their capability was preserved and the location and frequency of care were acceptable. Subgroups may prioritize survival, hospital avoidance, or in-center care. Clinicians supporting people making kidney failure treatment decisions must explore their goals and values. Thus, investment in services that prioritize capability and ensure treatment is delivered at a frequency acceptable to people in their preferred location would enable provision of preference sensitive care.

中文翻译：

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老年患者对肾衰竭治疗偏好的选择实验


大多数患有肾衰竭的老年患者在透析治疗或保守肾脏管理之间进行选择。人们对这些决定背后的偏好知之甚少。在这里，我们进行了一项以定性研究为依据的选择实验，以检查 eGFR 为 20 mls 或低于/min/1.73m2 的 65 岁以上人群对透析和保守管理特征的偏好。混合 logit 和 latent 类别分析量化了治疗频率和位置、生存率和能力（进行重要活动的能力）之间的权衡，并考虑了参与者的特征。总体而言，来自 23 个中心的 327 名英国参与者（中位年龄 77 岁，eGFR 14 mls/min/1.73m 2）在开始治疗两年后需要 8%-59% 的绝对生存率才能接受透析，更喜欢较少的治疗和在家治疗。在合作参与者中观察到的生存偏好显著更高 （效应量 0.04,95% 置信区间 0.02-0.06） 以及描述更好的能力水平 （效应量 0.02， 0.01-0.03）。确定了三个潜在类别，它们对生存、能力和护理地点具有不同的偏好。陈述的偏好表明参与者喜欢更高的生存概率，但前提是他们的能力得到保留并且护理的地点和频率是可接受的。亚组可能优先考虑生存、避免住院或中心护理。支持患者做出肾衰竭治疗决策的临床医生必须探索他们的目标和价值观。因此，对优先考虑能力并确保以人们在首选地点可接受的频率提供治疗的服务进行投资，将能够提供对偏好敏感的护理。