Patients with end-stage kidney disease have different expectations than their doctors
Eureka Alert | Kelly Lawman
Beth Israel Deaconess Medical Center research suggests that improved communication could help with end of life decision making.
BOSTON â€" In any given year, 400,000 Americans suffering from end-stage kidney disease will undergo dialysis, and as many as 20 to 25 percent of those dialysis patients will die, a statistic comparable to many types of cancer. But while cancer doctors may be more accustomed to talking with patients about the likely course of their disease, a new study from Beth Israel Deaconess Medical Center finds that doctors who treat patients with kidney failure are reluctant to discuss a difficult prognosis, and their patients are likely to have distorted expectations about their own probable outcomes.
The results of the study appear online, May 27th in JAMA Internal Medicine.
"Our study suggests that we may not be serving these patients as well as we could. These missed opportunities and misperceptions may actually be influencing patients' goals of care," says lead author Melissa W. Wachterman, MD, MPH, MSc, who conducted the research while a fellow in BIDMC's Division of General Medicine and Primary Care. "Giving seriously-ill patients a realistic sense of their own illness can be important so they can make informed medical and life decisions moving forward."
The researchers interviewed 62 seriously-ill patients from two Boston area dialysis centers whose predicted one-year mortality, based on two validated prognostic models, was at least 20 percent. They found that patients were significantly more optimistic than their doctors about one and five year survival. "Overall, 81 percent of patients thought they had at least a 90 percent chance of being alive in one year, whereas nephrologists were this optimistic for only 25 percent of patients," the authors write.
Beth Israel Deaconess Medical Center research suggests that improved communication could help with end of life decision making.
BOSTON â€" In any given year, 400,000 Americans suffering from end-stage kidney disease will undergo dialysis, and as many as 20 to 25 percent of those dialysis patients will die, a statistic comparable to many types of cancer. But while cancer doctors may be more accustomed to talking with patients about the likely course of their disease, a new study from Beth Israel Deaconess Medical Center finds that doctors who treat patients with kidney failure are reluctant to discuss a difficult prognosis, and their patients are likely to have distorted expectations about their own probable outcomes.
The results of the study appear online, May 27th in JAMA Internal Medicine.
"Our study suggests that we may not be serving these patients as well as we could. These missed opportunities and misperceptions may actually be influencing patients' goals of care," says lead author Melissa W. Wachterman, MD, MPH, MSc, who conducted the research while a fellow in BIDMC's Division of General Medicine and Primary Care. "Giving seriously-ill patients a realistic sense of their own illness can be important so they can make informed medical and life decisions moving forward."
The researchers interviewed 62 seriously-ill patients from two Boston area dialysis centers whose predicted one-year mortality, based on two validated prognostic models, was at least 20 percent. They found that patients were significantly more optimistic than their doctors about one and five year survival. "Overall, 81 percent of patients thought they had at least a 90 percent chance of being alive in one year, whereas nephrologists were this optimistic for only 25 percent of patients," the authors write.
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