Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/20153
Title
The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?
Author(s)
Date issued
2015-10-14
Citation
Prieto-Velasco M, Quiros P, Remon C, Spanish Grp Implementation. The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia?. PLoS One. 2015 Oct 14;10(10):e0138811.
Language
Inglés
Document type
research article
Abstract
Introduction It is desirable for patients to play active roles in the choice of renal replacement therapy (RRT). Patient decision aid tools (PDAs) have been developed to allow the patients to choose the option best suited to their individual needs. Material and Methods An observational, prospective registry was conducted in 26 Spanish hospitals between September 2010 and May 2012. The results of the patients' choice and the definitive RRT modality were registered through the progressive implementation of an Education Process (EP) with PDAs designed to help Chronic Kidney Disease (CKD) patients choose RRT. Results Patients included in this study: 1044. Of these, 569 patients used PDAs and had made a definitive choice by the end of registration. A total of 88.4% of patients chose dialysis [43% hemodialysis (HD) and 45% peritoneal dialysis (PD)] 3.2% preemptive living-donor transplant (TX), and 8.4% conservative treatment (CT). A total of 399 patients began RRT during this period. The distribution was 93.4% dialysis (53.6% HD; 40% PD), 1.3% preemptive TX and 5.3% CT. The patients who followed the EP changed their mind significantly less often [kappa value of 0.91 (95% CI, 0.86-0.95)] than those who did not follow it, despite starting unplanned treatment [kappa value of 0.85 (95% CI, 0.75-0.95]. A higher agreement between the final choice and a definitive treatment was achieved by the EP and planned patients [kappa value of 0.93 (95% CI, 0.89-0.98)]. Those who did not go through the EP had a much lower index of choosing PD and changed their decision more frequently when starting definitive treatment [kappa value of 0.73 (95% CI, 0.55-0.91)]. Conclusions Free choice, assisted by PDAs, leads to a 50/50 distribution of PD and HD choice and an increase in TX choice. The use of PDAs, even with an unplanned start, achieved a high level of concordance between the chosen and definitive modality.
MESH
Aged | Choice Behavior | Decision Making | Spain | Humans | Health Knowledge, Attitudes, Practice | Renal Dialysis | Kidney Failure, Chronic | Middle Aged | Decision Support Techniques | Male | Patient Participation | Prospective Studies | Female | Registries
DECS
Femenino | Masculino | Diálisis Renal | Técnicas de Apoyo para la Decisión | Humanos | Fallo Renal Crónico | Persona de Mediana Edad | Participación del Paciente | Estudios Prospectivos | Conocimientos, Actitudes y Práctica en Salud | Anciano | Conducta de Elección | Toma de Decisiones | España | Sistema de Registros
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