Perspectives of continuous renal replacement therapy in the intensive care unit: a paired survey study of patient, physician, and nurse views

BMC Nephrology

Ishir Bhan¹  Ednan Bajwa²  Katherine Cosgrove²  Rajeev Chorghade¹  Gregory Hundemer³  Andrew S. Allegretti¹ 

[1] Divsion of Nephrology, Department of Medicine, Massachusetts General Hospital, 7 Whittier Place, Suite 106, Boston 02114, MA, USA;Divsion of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA;Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

关键词: Survey;    Patient and provider perspectives;    Mismatch;    Kidney injury;    Intensive care unit;    Continuous renal replacement therapy;   

Others  :  1220010
DOI  :  10.1186/s12882-015-0086-5

 received in 2015-01-15, accepted in 2015-06-10,  发布年份 2015

【 摘 要 】

Background

Recent studies suggest discrepancies between patients and providers around perceptions of hemodialysis prognosis. Such data are lacking for continuous renal replacement therapy (CRRT). We aim to assess patient and provider understanding of outcomes around CRRT.

Methods

From February 1 to August 31, 2013, a triad of (1) a patient on CRRT (or health care proxy [HCP]), (2) physician and (3) primary nurse from the intensive care unit (ICU) team were surveyed. Univariate chi-square and qualitative analysis techniques were used.

Results

Ninety-six total participants (32 survey triads) were completed. Ninety one percent of patients/HCPs correctly identified that CRRT replaced the function of the kidneys. Six percent of patients/HCPs, 44 % of physicians, and 44 % of nurses identified rates of survival to hospital discharge that were consistent with published literature. Both physicians and nurses were more likely than patients/HCPs to assess survival consistently with published data (p = 0.001). Patients/HCPs were more likely to overestimate survival rates than physicians and nurses (p < 0.001). Thirty eight percent of patients/HCPs, 38 % of physicians, and 28 % of nurses identified rates of lifelong dialysis-dependence among surviving patients that were consistent with published literature.

Conclusions

There is mismatch between patients, HCPs, and providers around prognosis of CRRT. Patients/HCPs are more likely to overestimate chances of survival than physicians or nurses. Further intervention is needed to improve this knowledge gap.

【 授权许可】

   
2015 Allegretti et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Tolwani A. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med. 2012; 367(26):2505-2514.
• [2]Arulkumaran N, Annear NM, Singer M. Patients with end-stage renal disease admitted to the intensive care unit: systematic review. Br J Anaesth. 2012; 110(1):13-20.
• [3]Allegretti AS, Steele DJ, David-Kasdan JA, Bajwa E, Niles JL, Bhan I. Continuous renal replacement therapy outcomes in acute kidney injury and end-stage renal disease: a cohort study. Crit Care. 2013; 17(3):R109. BioMed Central Full Text
• [4]Bell M, Granath F, Schon S, Lofberg E, SWING, Ekbom A et al.. End-stage renal disease patients on renal replacement therapy in the intensive care unit: short- and long-term outcome. Crit Care Med. 2008; 36(10):2773-2778.
• [5]Sasaki S, Gando S, Kobayashi S, Nanzaki S, Ushitani T, Morimoto Y et al.. Predictors of mortality in patients treated with continuous hemodiafiltration for acute renal failure in an intensive care setting. ASAIO J. 2001; 47(1):86-91.
• [6]Tumlin JA, Chawla L, Tolwani AJ, Mehta R, Dillon J, Finkel KW et al.. The effect of the selective cytopheretic device on acute kidney injury outcomes in the intensive care unit: a multicenter pilot study. Semin Dial. 2012; 26(5):616-23.
• [7]Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S et al.. Beginning and Ending Supportive Therapy for the Kidney (BEST kidney) investigators: acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005; 294(7):813-818.
• [8]Delannoy B, Floccard B, Thiolliere F, Kaaki M, Badet M, Rosselli S et al.. Six-month outcome in acute kidney injury requiring renal replacement therapy in the ICU: a multicentre prospective study. Intensive Care Med. 2009; 35(11):1907-1915.
• [9]Gill TM. The central role of prognosis in clinical decision making. JAMA. 2012; 307(2):199-200.
• [10]A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995; 274((20):1591-1598.
• [11]Chochinov HM, Tataryn DJ, Wilson KG, Ennis M, Lander S. Prognostic awareness and the terminally ill. Psychosomatics. 2000; 41(6):500-504.
• [12]Weeks JC, Cook EF, O’Day SJ, Peterson LM, Wenger N, Reding D et al.. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA. 1998; 279(21):1709-1714.
• [13]Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J et al.. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003; 327(7408):195-198.
• [14]Siminoff LA, Fetting JH, Abeloff MD. Doctor-patient communication about breast cancer adjuvant therapy. J Clin Oncol. 1989; 7(9):1192-1200.
• [15]Pronzato P, Bertelli G, Losardo P, Landucci M. What do advanced cancer patients know of their disease? a report from Italy. Support Care Cancer. 1994; 2(4):242-244.
• [16]Eidinger RN, Schapira DV. Cancer patients’ insight into their treatment, prognosis, and unconventional therapies. Cancer. 1984; 53(12):2736-2740.
• [17]Wachterman MW, Marcantonio ER, Davis RB, Cohen RA, Waikar SS, Phillips RS et al.. Relationship between the prognostic expectations of seriously ill patients undergoing hemodialysis and their nephrologists. JAMA Intern Med. 2013; 173(13):1206-1214.
• [18]Curtis JR, Tonelli MR. Shared decision-making in the ICU: value, challenges, and limitations. Am J Respir Crit Care Med. 2011; 183(7):840-841.
• [19]Curtis JR, Vincent JL. Ethics and end-of-life care for adults in the intensive care unit. Lancet. 2010; 376(9749):1347-1353.
• [20]Daly BJ, Douglas SL, O’Toole E, Gordon NH, Hejal R, Peerless J et al.. Effectiveness trial of an intensive communication structure for families of long-stay ICU patients. Chest. 2010; 138(6):1340-1348.
• [21]White DB, Braddock CH 3rd, Bereknyei S, Curtis JR. Toward shared decision making at the end of life in intensive care units: opportunities for improvement. Arch Intern Med. 2007; 167(5):461-467.
• [22]Burns JP, Mello MM, Studdert DM, Puopolo AL, Truog RD, Brennan TA. Results of a clinical trial on care improvement for the critically ill. Crit Care Med. 2003; 31(8):2107-2117.
• [23]Boyd EA, Lo B, Evans LR, Malvar G, Apatira L, Luce JM et al.. “It’s not just what the doctor tells me:” factors that influence surrogate decision-makers’ perceptions of prognosis. Crit Care Med. 2010; 38((5):1270-1275.
• [24]Demirjian S, Chertow GM, Zhang JH, O’Connor TZ, Vitale J, Paganini EP et al.. VA/NIH acute renal failure trial network: model to predict mortality in critically ill adults with acute kidney injury. Clin J Am Soc Nephrol. 2011; 6(9):2114-2120.
• [25]Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, Tan I et al.. Beginning and Ending Supportive Therapy for the Kidney (B.E.S.T. Kidney) investigators: external validation of severity scoring systems for acute renal failure using a multinational database. Crit Care Med. 2005; 33(9):1961-1967.
• [26]Bagshaw SM, Laupland KB, Doig CJ, Mortis G, Fick GH, Mucenski M et al.. Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study. Crit Care. 2005; 9(6):R700-9. BioMed Central Full Text
• [27]Bagshaw SM, Mortis G, Doig CJ, Godinez-Luna T, Fick GH, Laupland KB. One-year mortality in critically ill patients by severity of kidney dysfunction: a population-based assessment. Am J Kidney Dis. 2006; 48(3):402-409.
• [28]Brar H, Olivier J, Lebrun C, Gabbard W, Fulop T, Schmidt D. Predictors of mortality in a cohort of intensive care unit patients with acute renal failure receiving continuous renal replacement therapy. Am J Med Sci. 2008; 335(5):342-347.
• [29]Clermont G, Acker CG, Angus DC, Sirio CA, Pinsky MR, Johnson JP. Renal failure in the ICU: comparison of the impact of acute renal failure and end-stage renal disease on ICU outcomes. Kidney Int. 2002; 62(3):986-996.
• [30]Fertmann J, Wolf H, Kuchenhoff H, Hofner B, Jauch KW, Hartl WH. Prognostic factors in critically ill surgical patients requiring continuous renal replacement therapy. J Nephrol. 2008; 21(6):909-918.
• [31]Lin YF, Ko WJ, Chu TS, Chen YS, Wu VC, Chen YM et al.. The 90-day mortality and the subsequent renal recovery in critically ill surgical patients requiring acute renal replacement therapy. Am J Surg. 2009; 198(3):325-332.
• [32]Ostermann M, Chang RW. Correlation between parameters at initiation of renal replacement therapy and outcome in patients with acute kidney injury. Crit Care. 2009; 13(6):R175. BioMed Central Full Text
• [33]Rocha E, Soares M, Valente C, Nogueira L, Bonomo H, Godinho M et al.. Outcomes of critically ill patients with acute kidney injury and end-stage renal disease requiring renal replacement therapy: a case–control study. Nephrol Dial Transplant. 2009; 24(6):1925-1930.
• [34]Uchino S. The epidemiology of acute renal failure in the world. Curr Opin Crit Care. 2006; 12(6):538-543.
• [35]Crabtree BF, Miller WL. Doing qualitative research. 2nd ed. Sage Publications, Thousand Oaks, Calif; 1999.
• [36]Patton MQ. University of California, Los Angeles. Center for the study of evaluation: how to use qualitative methods in evaluation . Sage Publications, Newbury Park, Calif; 1987.
• [37]Poses RM, Bekes C, Winkler RL, Scott WE, Copare FJ. Are two (inexperienced) heads better than one (experienced) head? averaging house officers’ prognostic judgments for critically ill patients. Arch Intern Med. 1990; 150(9):1874-1878.
• [38]Poses RM, McClish DK, Bekes C, Scott WE, Morley JN. Ego bias, reverse ego bias, and physicians’ prognostic. Crit Care Med. 1991; 19(12):1533-1539.
• [39]Poses RM, Smith WR, McClish DK, Huber EC, Clemo FL, Schmitt BP et al.. Physicians’ survival predictions for patients with acute congestive heart failure. Arch Intern Med. 1997; 157(9):1001-1007.
• [40]Lins RL, Elseviers MM, Van der Niepen P, Hoste E, Malbrain ML, Damas P et al.. SHARF investigators: intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transplant. 2009; 24(2):512-518.
• [41]Block L, Habicht R, Wu AW, Desai SV, Wang K, Silva KN et al.. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med. 2013; 28(8):1042-1047.
• [42]Westbrook JI, Duffield C, Li L, Creswick NJ. How much time do nurses have for patients? a longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Serv Res. 2011; 11:319-6963. BioMed Central Full Text
• [43]Rodriguez RM, Navarrete E, Schwaber J, McKleroy W, Clouse A, Kerrigan SF et al.. A prospective study of primary surrogate decision makers’ knowledge of intensive care. Crit Care Med. 2008; 36(5):1633-1636.
• [44]Shalowitz DI, Garrett-Mayer E, Wendler D. The accuracy of surrogate decision makers: a systematic review. Arch Intern Med. 2006; 166(5):493-497.
• [45]Ahalt C, Walter LC, Yourman L, Eng C, Perez-Stable EJ, Smith AK. “Knowing is better”: preferences of diverse older adults for discussing prognosis. J Gen Intern Med. 2012; 27(5):568-575.
• [46]Smith AK, Williams BA, Lo B. Discussing overall prognosis with the very elderly. N Engl J Med. 2011; 365(23):2149-2151.
• [47]Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Legare F, Thomson R: Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011, (10):CD001431. doi(10):CD001431.
• [48]El-Jawahri A, Podgurski LM, Eichler AF, Plotkin SR, Temel JS, Mitchell SL et al.. Use of video to facilitate end-of-life discussions with patients with cancer: a randomized controlled trial. J Clin Oncol. 2010; 28(2):305-310.
• [49]Epstein AS, Volandes AE, Chen LY, Gary KA, Li Y, Agre P et al.. A randomized controlled trial of a cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients. J Palliat Med. 2013; 16(6):623-631.
• [50]McCannon JB, O’Donnell WJ, Thompson BT, El-Jawahri A, Chang Y, Ananian L et al.. Augmenting communication and decision making in the intensive care unit with a cardiopulmonary resuscitation video decision support tool: a temporal intervention study. J Palliat Med. 2012; 15(12):1382-1387.
• [51]Volandes AE, Ferguson LA, Davis AD, Hull NC, Green MJ, Chang Y et al.. Assessing end-of-life preferences for advanced dementia in rural patients using an educational video: a randomized controlled trial. J Palliat Med. 2011; 14(2):169-177.
• [52]Volandes AE, Levin TT, Slovin S, Carvajal RD, O’Reilly EM, Keohan ML et al.. Augmenting advance care planning in poor prognosis cancer with a video decision aid: a preintervention-postintervention study. Cancer. 2012; 118(17):4331-4338.
• [53]Volandes AE, Paasche-Orlow MK, Mitchell SL, El-Jawahri A, Davis AD, Barry MJ et al.. Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer. J Clin Oncol. 2013; 31(3):380-386.