演題情報

Symposium

開催回
第60回・2015年・横浜
 

Decision/timing of dialysis initiation among elderly patients: A patient-centered approach

演題番号 : GI-10-4-3

Ann Margaret O’Hare:1

1:Department of Medicine, University of Washington, USA

 

The last several decades have witnessed the emergence of evidence-based medicine as the dominant paradigm for medical teaching, research and practice. Under an evidence-based approach, populations rather than individuals become the primary focus of investigation. Treatment priorities are largely shaped by the availability, relevance and quality of evidence and study outcomes and results are assumed to have more or less universal significance based on their implications at the population level. However, population-level treatment goals do not always align with what matters the most to individual patients-who may weigh the risks, benefits and harms of recommended treatments quite differently. In this talk, I will explore the potential value of a more patient-centered approach to the care of older adults with kidney disease focusing on decisions about whether and when to initiate maintenance dialysis. Key components of this approach include eliciting patient goals and values, estimating and communicating information on prognosis and expected illness trajectory, interpreting available evidence in the context of each patient's unique situation, assessing the clinical feasiblity of different treatment options and developing and optimizing an overall plan of care that best meets each patient's goals. I will argue that efforts to develop strong positive alternatives to dialysis for those who choose not to pursue this treatment, better integration of treatment decisions about conservative care with those related to modality selection, more ready access to palliative care services and more flexible approaches toward dialysis prescription could all have value in supporting the goals of individual patients. Finally, I will argue that regardless of the chosen treatment strategy, time can often be a critical ally in centering care on what matters most to the patient, and a flexible and iterative approach of re-evaluation and redirection may often be needed to ensure that treatment strategies are fully aligned with patient priorities.

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