Healthcare decision-making in end stage renal disease-patient preferences and clinical correlates

BMC Nephrology

Sandip Mitra²  Paul Brenchley²  Philip Foden⁴  Julie Morris⁴  Alison Wearden¹  Markus Neuvonen³  Anuradha Jayanti² 

[1] Department of Psychology, University of Manchester, Manchester, UK;Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;Department of Political and Economic Studies, University of Helsinki, Helsinki, Finland;Department of Biostatistics, University of Manchester, Manchester, UK

关键词: Cognition;    Decision-making;    Autonomy;    Haemodialysis;   

Others  :  1234474
DOI  :  10.1186/s12882-015-0180-8

 received in 2015-03-14, accepted in 2015-10-29,  发布年份 2015

【 摘 要 】

Background

Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood.

Methods

535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluated. Patients were enrolled into 3 groups- ‘predialysis’ (group A), ‘in-centre’ haemodialysis (HD) (group B) and self-care HD (93 % at home-group C) from across five tertiary UK renal centres. The Autonomy Preference Index (API) has been employed to study patient preferences for information-seeking (IS) and decision-making (DM). Demographic, psychosocial and neuropsychometric assessments are considered for analyses.

Results

458 complete responses were available. API items have high internal consistency in the study population (Cronbach’s alpha > 0.70). Overall and across individual study groups, the scores for information-seeking and decision-making are significantly different indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in DM (p < 0.05). In the age, education and study group adjusted multiple linear regression analysis, lower age, female gender, marital status; higher API IS scores and white ethnicity background were significant predictors of preference for decision-making. DM scores were subdivided into tertiles to identify variables associated with high (DM > 70: and low DM (≤30) scores. This shows association of higher DM scores with lower age, lower comorbidity index score, higher executive brain function, belonging in the self-caring cohort and being unemployed. In the prospectively studied cohort of predialysis patients, there was no change in decision-making preference scores after commencement of dialysis.

Conclusion

ESRD patients prefer to receive information, but this does not always imply active involvement in decision-making. By understanding modifiable and non-modifiable factors which affect patient preferences for involvement in healthcare decision-making, health professionals may acknowledge the need to accommodate individual patient preferences to the extent determined by the individual patient factors.

【 授权许可】

   
2015 Jayanti et al.

【 图 表 】

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