Evidence map›Paper›PMID 39574029›Full record

Observational studyBMC nephrology2024

Communicating treatment options to older patients with advanced kidney disease: a conversation analysis study.

Lucy E Selman, Chloe B Shaw, Ryann Sowden, Fliss E M Murtagh, James A Tulsky, Ruth Parry, Fergus J Caskey, Rebecca K Barnes

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC nephrology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Trial
  2. Review
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Lucy E SelmanPalliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. lucy.selman@bristol.ac.uk.
Chloe B ShawPalliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Ryann SowdenPalliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
Fliss E M MurtaghWolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
James A TulskyDana-Farber Cancer Institute, Harvard Medical School Boston, Boston, MA, USA.
Ruth ParryLoughborough University, Loughborough, UK.
Fergus J CaskeyUniversity of Bristol, Bristol Medical School, Bristol, UK.
Rebecca K BarnesNuffield Department Primary Care Health Sciences, University of Oxford, Oxford, UK.

Funding

National Institute for Health and Care Research CDF-2018-11-ST2-009National Institute for Health and Care Research Senior Investigator
6 · The paper itself

Abstract

backgroundChoosing to have dialysis or conservative kidney management is often challenging for older people with advanced kidney disease. While we know that clinical communication has a major impact on patients' treatment decision-making, little is known about how this occurs in practice. The OSCAR study (Optimising Staff-Patient Communication in Advanced Renal disease) aimed to identify how clinicians present kidney failure treatment options in consultations with older patients and the implications of this for patient engagement.

methodsAn observational, multi-method study design was adopted. Outpatient consultations at four UK renal units were video-recorded, and patients completed a post-consultation measure of shared decision-making (SDM-Q-9). Units were sampled according to variable rates of conservative management. Eligible patients were ≥ 65 years old with an eGFR of ≤ 20 mls/min/1.73m

results110 outpatient consultations were recorded (105 video, 5 audio only), involving 38 clinicians (doctors and nurses) and 94 patients: mean age 77 (65-97); 61 males/33 females; mean eGFR 15 (range 4-23). There were 21 instances where clinicians presented both dialysis and conservative management. Two main practices were identified: (1) Conservative management and dialysis both presented as the main treatment options; (2) Conservative management presented as a subordinate option to dialysis. The first practice was less commonly used (6 vs. 15 cases), but associated with more opportunities in the conversation for patients to ask questions and share their perspective, through which they tended to evaluate conservative management as an option that was potentially personally relevant. This practice was also associated with significantly higher post-consultation ratings of shared decision-making among patients (SDM-Q-9 median total score 24 vs. 37, p = 0.041).

conclusionsPresenting conservative management and dialysis as on an equal footing enables patient to take a more active role in decision-making. Findings should inform clinical communication skills training and education. CLINICAL TRIAL NUMBER: No trial number as this is not a clinical trial.

Indexed as

CommunicationConservative TreatmentDecision Making, SharedPhysician-Patient RelationsRenal DialysisAgedAged, 80 and overFemaleHumansKidney Failure, ChronicMalePatient ParticipationVideo RecordingCommunicationConservative treatmentHospitalOutpatient clinicsPalliative careRenal dialysisShared decision-making

Identifiers

PMID39574029
PMCPMC11580699

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.