Abstract
Background: Most patients with end-stage renal disease (ESRD) are managed with dialysis and less commonly kidney transplantation. However, not all are suitable for or desire either of these renal replacement therapies. Conservative management (CM) is an option. However, the selection of CM is often not easy for patients and clinicians. The aim of this systematic review is to identify the key factors that influence the selection of CM for ESRD.
Methods: Medline, Embase, PsychINFO, and CINAHL Plus were systematically searched from inception to September 10, 2021. Titles/abstracts and full texts were independently screened by two reviewers. Reference lists of included articles were searched. An update search via PubMed was conducted on August 10, 2023. A narrative synthesis of review findings was conducted.
Results: At the end of the screening process, 15 qualitative and 8 survey articles were selected. Reference checking yielded no additional relevant studies. Main themes were: (i) Patient-specific factors; (ii) Clinician-specific factors; (iii) Organisational factors; and (iv) National and international factors.
Patient-specific factors were awareness and perceptions of CM and dialysis, beliefs about survival, preferred treatment outcomes and influence of family/caregivers and clinicians. Clinician-specific factors included perceptions of CM as ‘non-intervention’, perceptions of clinician role in the decision-making process, and confidence and ability to initiate sensitive treatment discussions. Relationships with and involvement of other healthcare professionals, time constraints, and limited clinical guidance were also important factors.
Conclusions: An improvement in the provision of education regarding CM for patients, caregivers, and clinicians is essential. Robust studies are required to generate crucial evidence for the development of stronger recommendations and guidance for clinicians.
Methods: Medline, Embase, PsychINFO, and CINAHL Plus were systematically searched from inception to September 10, 2021. Titles/abstracts and full texts were independently screened by two reviewers. Reference lists of included articles were searched. An update search via PubMed was conducted on August 10, 2023. A narrative synthesis of review findings was conducted.
Results: At the end of the screening process, 15 qualitative and 8 survey articles were selected. Reference checking yielded no additional relevant studies. Main themes were: (i) Patient-specific factors; (ii) Clinician-specific factors; (iii) Organisational factors; and (iv) National and international factors.
Patient-specific factors were awareness and perceptions of CM and dialysis, beliefs about survival, preferred treatment outcomes and influence of family/caregivers and clinicians. Clinician-specific factors included perceptions of CM as ‘non-intervention’, perceptions of clinician role in the decision-making process, and confidence and ability to initiate sensitive treatment discussions. Relationships with and involvement of other healthcare professionals, time constraints, and limited clinical guidance were also important factors.
Conclusions: An improvement in the provision of education regarding CM for patients, caregivers, and clinicians is essential. Robust studies are required to generate crucial evidence for the development of stronger recommendations and guidance for clinicians.
| Original language | English |
|---|---|
| Article number | sfad269 |
| Journal | Clinical Kidney Journal |
| Volume | 17 |
| Issue number | 1 |
| Early online date | 17 Oct 2023 |
| DOIs | |
| Publication status | Published - 1 Jan 2024 |
Bibliographical note
Funding:This project is funded as part of the Health Foundation’s PhDs in improvement science programme. The Health Foundation is an independent charitable organisation working to build a healthier UK. The Health Foundation was not involved in any other aspect of the project.
OLA receives funding from the National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre (BRC), NIHR Applied Research Collaboration (ARC) West Midlands, NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, The Health Foundation, Innovate UK (part of UK Research and Innovation), Gilead Sciences Ltd, GlaxoSmithKline (GSK), Merck, Anthony Nolan, and Sarcoma UK.
This paper presents independent research and the views expressed in this publication are those of the author(s) and not necessarily those of the Health Foundation or the NIHR.
Keywords
- conservative care
- conservative management
- end-stage renal disease
- ESRD
- non-dialysis