Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.
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BACKGROUND: Early preparation for renal replacement therapy (RRT) is recommended for patients with advanced chronic kidney disease (CKD), yet many patients initiate RRT urgently and/or are inadequately prepared. METHODS: We conducted audio-recorded, qualitative, directed telephone interviews of nephrology health care providers (n = 10, nephrologists, physician assistants, and nurses) and primary care physicians (PCPs, n = 4) to identify modifiable challenges to optimal RRT preparation to inform future interventions. We recruited providers from public safety-net hospital-based and community-based nephrology and primary care practices. We asked providers open-ended questions to assess their perceived challenges and their views on the role of PCPs and nephrologist-PCP collaboration in patients' RRT preparation. Two independent and trained abstractors coded transcribed audio-recorded interviews and identified major themes. RESULTS: Nephrology providers identified several factors contributing to patients' suboptimal RRT preparation, including health system resources (e.g., limited time for preparation, referral process delays, and poorly integrated nephrology and primary care), provider skills (e.g., their difficulty explaining CKD to patients), and patient attitudes and cultural differences (e.g., their poor understanding and acceptance of their CKD and its treatment options, their low perceived urgency for RRT preparation; their negative perceptions about RRT, lack of trust, or language differences). PCPs desired more involvement in preparation to ensure RRT transitions could be as "smooth as possible", including providing patients with emotional support, helping patients weigh RRT options, and affirming nephrologist recommendations. Both nephrology providers and PCPs desired improved collaboration, including better information exchange and delineation of roles during the RRT preparation process. CONCLUSIONS: Nephrology and primary care providers identified health system resources, provider skills, and patient attitudes and cultural differences as challenges to patients' optimal RRT preparation. Interventions to improve these factors may improve patients' preparation and initiation of optimal RRTs.
SubjectAttitude of Health Personnel
Health Knowledge, Attitudes, Practice
Interviews as Topic
Physicians, Primary Care
Quality of Health Care
Referral and Consultation
Renal Insufficiency, Chronic
Renal Replacement Therapy
Published Version (Please cite this version)10.1186/s12882-015-0020-x
Publication InfoAmeling, JM; Andrews, CE; Boulware, Ebony; Cavanaugh, KL; Ephraim, Patti L; Gimenez, L; ... Umeukeje, E (2015). Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study. BMC Nephrol, 16. pp. 37. 10.1186/s12882-015-0020-x. Retrieved from http://hdl.handle.net/10161/10214.
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Eleanor Easley Chair in the School of Medicine
Ebony Boulware, MD, MPH is a Professor of Medicine, Chief of the Division of General Internal Medicine in the Department of Medicine, Vice Dean for Translational Science and Associate Vice Chancellor for Translational Research in the School of Medicine at Duke University. She received an A.B. from Vassar College, an M.D. from Duke University, and a M.P.H. from the Johns Hopkins Bloomberg School of Public Health. Dr. Boulware attended medical school at Duke University,