Prognostic dissonance of seriously ill HD patients
Research type
Research Study
Full title
Perceptions of illness severity, treatment goals and life expectancy: staff, patient and close person.
IRAS ID
202748
Contact name
Edwina Brown
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
0 years, 4 months, 1 days
Research summary
Sharing and communicating information with patients is an integral part of medical care, yet research has shown that disparities exist between physicians and patient perceptions of illness severity[1]. In renal medicine, along with many other specialties, expected prognosis can affect treatment offered. For example, for older patients with multiple comorbidities, risks of transplantation can outweigh benefits; it may be that transplantation is not the most appropriate treatment choice for an individual patient. Thus appreciating and understanding one’s prognosis can influence patients and relatives’ expectations for treatment and guide discussions regarding quality of life.
Previous work by Wachterman and colleagues has highlighted disparities in the United States between expectations of survival of seriously ill haemodialysis patients and their physicians[1]. We plan to repeat this study within the United Kingdom, to see whether similar issues occur and to elucidate current practice on discussions of prognosis, symptom burden and transplant candidacy. We hope to identify where care can be improved, through increased understanding of mismatches of perception. Ultimately we hope to develop strategies improving communication between physicians and patients.
Undertaking a qualitative approach, we plan to explore both patient and care givers understanding of their illness, symptom burden, transplant suitability and their goals of care. In addition to previous work, we will specifically include symptom assessment tools[2].
If similar practice to the United States is confirmed, we hope to establish whether interventions can be put in place to help facilitate open dialogue. We believe this will enable patients to better make informed decisions on treatment and goals of care.
References
[1]Wachterman M, Edward R, Marcantonio M et al. Relationship between the prognostic expectations of severely ill patients undergoing haemodialysis and their nephrologists.JAMA Int Med 2013;173(13)1206-1214.
[2] IPOS Renal. https://pos-pal.org/maix/ipos-renal-in-english.php Last accessed 25/09/17.REC name
London - Fulham Research Ethics Committee
REC reference
18/LO/0199
Date of REC Opinion
6 Mar 2018
REC opinion
Unfavourable Opinion