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

Greer, Raquel C

Ameling, Jessica M

Cavanaugh, Kerri L

Jaar, Bernard G

Grubbs, Vanessa

Andrews, Carrie E

Ephraim, Patti

Powe, Neil R

Lewis, Julia

Umeukeje, Ebele

Gimenez, Luis

James, Sam

Boulware, L Ebony

England

2015-06-12T11:56:37Z

2015-03-28

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.

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

10.1186/s12882-015-0020-x

1471-2369

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

eng

Springer Science and Business Media LLC

BMC Nephrol

10.1186/s12882-015-0020-x

Attitude of Health Personnel

Female

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

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

Journal article

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

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

37

Clinical Science Departments

Community and Family Medicine

Duke

Medicine

Medicine, General Internal Medicine

School of Medicine

Published online

16