• Taryn Oestreich, George Sayre, Ann M O'Hare, CurtisJ RandallJRUniversity of Washington, Seattle, WA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA., and WongSusan P YSPYUniversity of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA. Electronic address: spywong@uw.edu..
• University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA.
• Am. J. Kidney Dis. 2021 Mar 1; 77 (3): 355-364.e1.

Rationale & ObjectiveLittle is known about perceptions of conservative care among patients with advanced kidney disease in the United States.Study DesignQualitative study using cognitive interviewing about attitudes regarding conservative care using decision aids on treatments for advanced kidney disease developed outside the United States.Setting & Participants14 patients 75 years or older with advanced kidney disease, defined as estimated glomerular filtration rate≤20mL/min/1.73m2 and not receiving maintenance dialysis, and 6 of their family members.Analytical ApproachThematic analysis of participants' reactions to descriptions of conservative care taken from various clinical care decision aids.ResultsParticipants were mostly White (n=15) and had at least some college education (n=16). Four themes emerged from analysis of interviews: (1) core elements of conservative care: aspects of conservative care that were appealing to participants included a whole-person, team-based, and structured approach to care that focused on symptom management, maintaining current lifestyle, and managing health setbacks; (2) importance of how conservative care is framed: participants were more receptive to conservative care when this was framed as an active rather than passive treatment approach and were receptive to statements of uncertainty about future course of illness and prognosis; (3) an explicit approach to shared decision making: participants believed decisions about conservative care and dialysis should address considerations about risk and benefits of treatment options, family and clinician perspectives, and patients' goals, values, and preferences; and (4) relationship between conservative care and dialysis: although conservative care models outside the United States are generally intended to serve as an alternative to dialysis, participants' comments implied that they did not see conservative care and dialysis as mutually exclusive.LimitationsThemes identified may not generalize to the broader population of US patients with advanced kidney disease and their family members.ConclusionsParticipants were favorably disposed to a whole-person multidisciplinary approach to conservative care, especially when framed as an active treatment approach. Models of conservative care excluding the possibility of dialysis were less embraced, suggesting that current models will require adaptation to meet the needs of US patients and their families.Published by Elsevier Inc.

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