Dialysis decision-making process by Chinese American patients at an urban, academic medical center: a retrospective chart review.
BMC Palliat Care
; 23(1): 25, 2024 Jan 25.
Article
en En
| MEDLINE
| ID: mdl-38273297
ABSTRACT
BACKGROUND:
Clinical practice guidelines emphasize shared decision-making for kidney replacement treatment, yet little is known about the influence of cultural differences on that process. We undertook a retrospective chart review to explore the process and timing of dialysis decision making and initiation in Chinese American patients to provide quality kidney care for this population.DESIGN:
Participants received outpatient care at Tufts Medical Center and dialysis at Dialysis Clinic, Inc. Boston or Somerville, MA from 2001-2021. Clinic chart review sourced demographic, clinical, and end-of-life care information from 180 participants (82 Chinese American, 98 other) from stage 4 chronic kidney disease (CKD) and dialysis initiation.RESULTS:
Chinese American participants were older (mean 70 vs. 59, p < 0.0001), less likely to speak English (12% vs. 87%, p < 0.0001), and used interpreter services more (80% vs. 11%, p < 0.0001). Chinese American participants had more visits (median 14 vs. 10, p = 0.005); were more often accompanied by family members (75% vs. 40%, p < 0.001); and had significantly lower rates of healthcare proxy documentation (35% vs. 55%, p = 0.006). There was no statistical difference in months between first CKD 4 visit and first dialysis. Both groups started dialysis at the same average eGFR and with similar rates of permanent dialysis access. Chinese American participants had significantly lower serum albumin at dialysis initiation (mean 3.3 g/dL vs 3.7 g/dL, p = 0.0003). Documentation reflected a low number of conversations about non-dialytic care, end-of-life planning, or palliative care in both groups across all visits.CONCLUSION:
The time between CKD 4 and dialysis initiation was the same in both groups, suggesting a similar overall outcome of care. Chart documentation suggests that Chinese American participants had a significantly higher number of visits with nephrologists where discussion about dialysis was noted and were more likely to have a family member present at the visit. Fewer Chinese American participants completed healthcare proxies. Among all study participants, healthcare proxy, code status, and palliative care discussions were reported less frequently than expected. These findings highlight opportunities for collaboration between palliative care clinicians and nephrologists.Palabras clave
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Insuficiencia Renal Crónica
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Toma de Decisiones Clínicas
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Fallo Renal Crónico
Tipo de estudio:
Guideline
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Observational_studies
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Prognostic_studies
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Qualitative_research
Límite:
Humans
Idioma:
En
Revista:
BMC Palliat Care
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BMC palliat. care
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BMC palliative care
Año:
2024
Tipo del documento:
Article
País de afiliación:
Estados Unidos