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"它基本上是"拥有或死亡":对老年患者在透析和保守管理之间做出选择的定性研究
Barnaby Hole1,2, Leila Rooshenas2, Rachael Morton3
1Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, UK barnaby.hole@bristol.ac.uk.
BMJ open
|March 7, 2025
概括
患有功能衰竭的老年人往往认为透析是唯一的选择,忽视了保守的管理 (CKM). 改善教育对于有关透析与CKM的明智共享决策至关重要.
科学领域:
- 老年神经病学 老年神经病学
- 决策科学 决策科学 决策科学
背景情况:
- 患有功能衰竭的老年人除了透析或保守管理 (CKM) 外,治疗选择有限.
- 透析和CKM对老年人的寿命和生活质量的比较有效性仍然不确定.
- 有证据表明,老年患者可能无法获得足够的支持,以便在透析和CKM之间做出明智的决策.
研究的目的:
- 探索老年患者如何理解透析和保守管理 (CKM) 之间的决策.
- 确定影响老年衰竭患者在透析和CKM之间选择的因素.
主要方法:
- 使用半结构面试进行的定性研究.
- 在数据分析中使用了感应主题分析和常量比较技术.
- 针对三个英国脏单位的80岁以上 (或65岁以上具有并发症/脆弱性) 的成年人,其eGFR<20的有目的采样.
主要成果:
- 三个主要主题出现了:"做透析或死亡"的看法,被认为"需要"透析作为默认,和"权衡生活质量和数量".
- 参与者经常把没有透析等同于死亡,并低估了透析对生存的不确定的好处.
- 结果仅限于来自三个中心的白人英国人,这可能会影响概括性.
结论:
- 对选择的不熟悉,对生活的渴望和"做或死"的心态可能会导致老年人认为血液透析是不可避免的.
- 临床医生必须准确地介绍功能衰竭的治疗选择 (透析与CKM),并支持共享决策.
- 阐明治疗的不确定性和患者的优先事项对于尊重老年人对功能衰竭管理的选择至关重要.
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