Evidence map›Paper›PMID 31570175›Full record

ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2020

Experiences of US Nephrologists in the Delivery of Conservative Care to Patients With Advanced Kidney Disease: A National Qualitative Study.

Susan P Y Wong, Saritha Boyapati, Ruth A Engelberg, Bjorg Thorsteinsdottir, Janelle S Taylor, Ann M O'Hare

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 2 pooled it
4.0field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.

  1. Pooled it
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  8. Contraceptive Use and Reproductive Health in Women With CKD: A Qualitative Study of Nephrologists in the United States.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2026
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  18. Review
  19. When Patients Make Unexpected Medical Choices.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2023
    Article
  20. Results of the European EDITH nephrologist survey on factors influencing treatment modality choice for end-stage kidney disease.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2021
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Susan P Y WongKidney Research Institute, University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA. Electronic address: spywong@uw.edu.
Saritha BoyapatiDivision of Nephrology, University of Washington, Seattle, WA.
Ruth A EngelbergDivision of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA.
Bjorg ThorsteinsdottirMayo Clinic College of Medicine, Rochester, MN.
Janelle S TaylorDepartment of Anthropology, University of Washington, Seattle, WA.
Ann M O'HareKidney Research Institute, University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.
University of Washington · USVA Puget Sound Health Care System · USMayo Clinic · US

Funding

Evidence Based Encounter Decision Aid for Elderly Patients to Promote Shared Decision Making on Treatment Choice in End Stage Renal DiseaseK23AG051679 · NIA · MAYO CLINIC ROCHESTER · PI THORSTEINSDOTTIR, BJOERG · 2016 to 2020
$908k
Dialysis decision-making among adults with advanced kidney diseaseK23DK107799 · NIDDK · UNIVERSITY OF WASHINGTON · PI WONG, SUSAN PAMELA · 2016 to 2019
$657k
NIA NIH HHS K23 AG051679NIDDK NIH HHS K23 DK107799
6 · The paper itself

Abstract

RATIONALE &

objectiveIt is relatively unusual for US patients with advanced chronic kidney disease (CKD) to forgo initiation of maintenance dialysis. Our objective was to describe practice approaches of US nephrologists who have provided conservative care for members of this population. STUDY

designQualitative study using semi-structured interviews. SETTING &

participantsA national sample of 21 nephrologists experienced in caring for patients with advanced CKD who decided not to start dialysis. ANALYTICAL APPROACH: Grounded theory methods to identify dominant themes reflecting nephrologists' experiences with and approaches to conservative care for patients with advanced CKD.

resultsNephrologists who participated in this study were primarily from academic practices (n=14) and urban areas (n=15). Two prominent themes emerged from qualitative analysis reflecting nephrologists' experiences with and approaches to conservative care: (1) person-centered practices, which described a holistic approach to care that included basing treatment decisions on what mattered most to individual patients, framing dialysis as an explicit choice, being mindful of sources of bias in medical decision making, and being flexible to the changing needs, values, and preferences of patients; and (2) improvising a care infrastructure, which described the challenges of managing patients conservatively within health systems that are not optimally configured to support their needs. Participating nephrologists described cobbling together resources, assuming a range of different health care roles, preparing patients to navigate health systems in which initiation of dialysis served as a powerful default, and championing the principles of conservative care among their colleagues. LIMITATIONS: The themes identified likely are not generalizable to most US nephrologists.

conclusionsInsights from a select group of US nephrologists who are early adopters of conservative care signal the need for a stronger cultural and health system commitment to building care models capable of supporting patients who choose to forgo dialysis.

Indexed as

Clinical CompetenceClinical Decision-MakingQualitative ResearchConservative TreatmentFemaleHumansKidney Failure, ChronicMaleMiddle AgedNephrologistsRenal DialysisUnited Statesadvance care planning (ACP)advanced CKDchronic kidney disease (CKD)Conservative caredialysis initiationelderlyend-of-life caregeriatricsgoals of carehospicekidney failuremedical decision-makingnephrologist attitudesnondialytic carepalliative carepatient autonomypatient choicequalitative researchquality of life (QoL)renal supportive care

Identifiers

PMID31570175
PMCPMC7012760
OpenAlexW2977102649

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.