Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.
Abstract
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.
Type
Journal articleSubject
Attitude of Health PersonnelFemale
Health Knowledge, Attitudes, Practice
Humans
Interdisciplinary Communication
Interviews as Topic
Male
Nephrology
Physician-Patient Relations
Physicians, Primary Care
Qualitative Research
Quality of Health Care
Referral and Consultation
Renal Insufficiency, Chronic
Renal Replacement Therapy
Risk Assessment
Treatment Outcome
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https://hdl.handle.net/10161/10214Published Version (Please cite this version)
10.1186/s12882-015-0020-xPublication Info
Greer, Raquel C; Ameling, Jessica M; Cavanaugh, Kerri L; Jaar, Bernard G; Grubbs,
Vanessa; Andrews, Carrie E; ... Boulware, L Ebony (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 https://hdl.handle.net/10161/10214.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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L. Ebony Boulware
Nanaline Duke Distinguished Professor of Medicine
Dr. Boulware directs the Duke Clinical and Translational Science Institute as Vice
Dean for Translational Science and Associate Vice Chancellor for Translational Research,
and she is Chief of the Duke Division of General Internal Medicine in the Department
of Medicine. She is a general internist, physician-scientist and clinical epidemiologist
focused on improving health and h

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