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Discussions during shared decision-making in older adults with advanced renal disease: a scoping review


Raj, R and Thiruvengadam, S and Ahuja, KDK and Frandsen, M and Jose, M, Discussions during shared decision-making in older adults with advanced renal disease: a scoping review, BMJ Open, 9, (11) Article e031427. ISSN 2044-6055 (2019) [Refereed Article]

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Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC.

DOI: doi:10.1136/bmjopen-2019-031427


Objectives: This review summarises the information available for clinicians counselling older patients with kidney failure about treatment options, focusing on prognosis, quality of life, the lived experiences of treatment and the information needs of older adults.

Design: We followed the Joanna Briggs Institute Methodology for Scoping Reviews. The final report conforms to the PRISMA-ScR guidelines.

Data sources: PubMed, PsycINFO, CINAHL, Embase, Scopus, Web of Science, TRIP and online repositories (for dissertations, guidelines and recommendations from national renal associations).

Eligibility criteria for inclusion: Articles in English studying older adults with advanced kidney disease (estimated glomerular filtration rate <30 mL/min/1.73 m2); published between January 2000 and August 2018. Articles not addressing older patients separately or those comparing between dialysis modalities were excluded.

Data extraction and synthesis: Two independent reviewers screened articles for inclusion and grouped them by topic as per the objectives above. Quantitative data were presented as tables and charts; qualitative themes were identified and described.

Results: 248 articles were included after screening 15 445 initial results. We summarised prognostic scores and compared dialysis and non-dialytic care. We highlighted potentially modifiable factors affecting quality of life. From reports of the lived experiences, we documented the effects of symptoms, of ageing, the feelings of disempowerment and the need for adaptation. Exploration of information needs suggested that patients want to participate in decision-making and need information, in simple terms, about survival and non-survival outcomes.

Conclusion: When discussing treatment options, validated prognostic scores are useful. Older patients with multiple comorbidities do not do well with dialysis. The modifiable factors contributing to the low quality of life in this cohort deserve attention. Older patients suffer a high symptom burden and functional deterioration; they have to cope with significant life changes and feelings of disempowerment. They desire greater involvement and more information about illness, symptoms and what to expect with treatment.

Item Details

Item Type:Refereed Article
Keywords:elderly, ESRD, dialysis, scoping review, decision-making, supportive care
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Nephrology and urology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Raj, R (Dr Rajesh Raj)
UTAS Author:Ahuja, KDK (Dr Kiran Ahuja)
UTAS Author:Frandsen, M (Dr Mai Frandsen)
UTAS Author:Jose, M (Professor Matthew Jose)
ID Code:137114
Year Published:2019
Web of Science® Times Cited:9
Deposited By:Medicine
Deposited On:2020-02-02
Last Modified:2022-07-06
Downloads:27 View Download Statistics

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