ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2020
Medical Record Documentation of Goals-of-Care Discussions Among Older Veterans With Incident Kidney Failure.
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 6 papers.
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Who cites it
6 citing papers in PubMed, 13 citations in OpenAlex.
- Cardiorenal Syndrome in the Elderly: Challenges and Considerations.Geriatrics (Basel, Switzerland) · 2025Review
- Communicating to the Intellect, Heart, and Person: A Model Describing Participants' Experience of Goals of Care Discussions Conducted During Acute Inpatient Care.Palliative medicine reports · 2025Article
- Advance care planning for patients with end-stage kidney disease on dialysis: narrative review of the current evidence, and future considerations.Journal of nephrology · 2024Review
- The VA Life-Sustaining Treatment Decisions Initiative: A qualitative analysis of veterans with advanced kidney disease.Journal of the American Geriatrics Society · 2022Article
- Article
- Cardiopulmonary Resuscitation Preferences of People Receiving Dialysis.JAMA network open · 2020Article
Corrections and comments
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
Abstract
RATIONALE &
objectiveElicitation and documentation of patient preferences is at the core of shared decision making and is particularly important among patients with high anticipated mortality. The extent to which older patients with incident kidney failure undertake such discussions with their providers is unknown and its characterization was the focus of this study. STUDY
designRetrospective cohort study. SETTING &
participantsA random sample of veterans 67 years and older with incident kidney failure receiving care from the US Veterans Health Administration between 2005 and 2010. EXPOSURES: Demographic and facility characteristics, as well as predicted 6-month mortality risk after dialysis initiation and documentation of resuscitation preferences. OUTCOMES: Documented discussions of dialysis treatment and supportive care. ANALYTICAL APPROACH: We reviewed medical records over the 2 years before incident kidney failure and up to 1 year afterward to ascertain the frequency and timing of documented discussions about dialysis treatment, supportive care, and resuscitation. Logistic regression was used to identify factors associated with these documented discussions.
resultsThe cohort of 821 veterans had a mean age of 80.9±7.2 years, and 37.2% had a predicted 6-month mortality risk>20% with dialysis. Documented discussions addressing dialysis treatment and resuscitation were present in 55.6% and 77.1% of patients, respectively. Those addressing supportive care were present in 32.4%. The frequency of documentation varied by mortality risk and whether the patient ultimately started dialysis. In adjusted analyses, the frequency and pattern of documentation were more strongly associated with geographic location and receipt of outpatient nephrology care than with patient demographic or clinical characteristics. LIMITATIONS: Documentation may not fully reflect the quality and content of discussions, and generalizability to nonveteran patients is limited.
conclusionsAmong older veterans with incident kidney failure, discussions of dialysis treatment are decoupled from other aspects of advance care planning and are suboptimally documented, even among patients at high risk for mortality.
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