Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.

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Greer, Raquel C

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Ameling, Jessica M

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Cavanaugh, Kerri L

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Jaar, Bernard G

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Grubbs, Vanessa

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Andrews, Carrie E

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Ephraim, Patti

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Powe, Neil R

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Lewis, Julia

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Umeukeje, Ebele

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Gimenez, Luis

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James, Sam

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Boulware, L Ebony

dc.coverage.spatial

England

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2015-06-12T11:56:37Z

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2015-03-28

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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.

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http://www.ncbi.nlm.nih.gov/pubmed/25885460

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10.1186/s12882-015-0020-x

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1471-2369

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https://hdl.handle.net/10161/10214

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eng

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Springer Science and Business Media LLC

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BMC Nephrol

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10.1186/s12882-015-0020-x

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Attitude of Health Personnel

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Female

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Health Knowledge, Attitudes, Practice

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Humans

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Interdisciplinary Communication

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Interviews as Topic

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Male

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Nephrology

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Physician-Patient Relations

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Physicians, Primary Care

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Qualitative Research

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Quality of Health Care

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Referral and Consultation

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Renal Insufficiency, Chronic

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Renal Replacement Therapy

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Risk Assessment

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Treatment Outcome

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Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study.

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Journal article

duke.contributor.orcid

Boulware, L Ebony|0000-0002-8650-4212

pubs.author-url

http://www.ncbi.nlm.nih.gov/pubmed/25885460

pubs.begin-page

37

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Clinical Science Departments

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Community and Family Medicine

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Duke

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Medicine

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Medicine, General Internal Medicine

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School of Medicine

pubs.publication-status

Published online

pubs.volume

16

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