Treatment Decision Making for Older Kidney Patients during COVID-19

Thalia Porteny*, Kristina M. Gonzales, Kate E. Aufort, Sarah Levine, John B. Wong, Tamara Isakova, Dena E. Rifkin, Elisa J. Gordon, Ana Rossi, Gary Di Perna, Susan Koch-Weser, Daniel E. Weiner, Keren Ladin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background and objectives Coronavirus disease 2019 (COVID-19) disrupted medical care across health care settings for older patients with advanced CKD. Understanding how shared decision making for kidney treatment decisions was influenced by the uncertainty of an evolving pandemic can provide insights for supporting shared decision making through the current and future public health crises. Design, setting, participants, & measurementsWe performed thematic and narrative analyses of semistructured interviews with patients (CKD stages 4 and 5, age 701), care partners, and clinicians from Boston, Portland (Maine), San Diego, and Chicago from August to December 2020. Results We interviewed 76 participants (39 patients, 17 care partners, and 20 clinicians). Among patient participants, 13 (33%) patients identified as Black, and seven (18%) had initiated dialysis. Four themes with corresponding subthemes emerged related to treatment decision making and the COVID-19 pandemic: (1) adapting to changed educational and patient engagement practices (patient barriers to care and new opportunities for telemedicine); (2) reconceptualizing vulnerability (clinician awareness of illness severity increased and limited discussions of patient COVID-19 vulnerability); (3) embracing home-based dialysis but not conservative management (openness to home-based modalities and limited discussion of conservative management and advanced care planning); and (4) satisfaction and safety with treatment decisions despite conditions of uncertainty. Conclusions Although clinicians perceived greater vulnerability among older patients CKD and more readily encouraged home-based modalities during the COVID-19 pandemic, their discussions of vulnerability, advance care planning, and conservative management remained limited, suggesting areas for improvement. Clinicians reported burnout caused by the pandemic, increased time demands, and workforce limitations, whereas patients remained satisfied with their treatment choices despite uncertainty.

Original languageEnglish (US)
Pages (from-to)957-965
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume17
Issue number7
DOIs
StatePublished - Jul 2022

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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