Official websites use. Share sensitive information only on official, secure websites. Older patients with advanced chronic kidney disease CKD use intensive care at the end of life and die in a hospital more frequently than patients with cancer or heart disease.
Advance care planning ACP can help align treatment with patient preferences and improve patient-centered care, yet ACP quality and experiences among older patients with CKD and their care partners remain incompletely understood, particularly among the nonβdialysis-dependent population. In-person interviewer-administered surveys of patients 70 years and older with nonβdialysis-dependent CKD stage 4 or 5 and their self-identified care partners. Completion of advance directives and self-reported perceptions, preferences, and experiences of ACP.
Descriptive analysis of patient and care partner surveys. McNemar test analysis to compare patient and care partner responses. Care partners were more likely than patients to report that they had experienced discussion components reflective of high-quality ACP with the clinical team.
Single metropolitan area; most patients did not identify a care partner; nonresponse bias and small sample size. Patients often believed that their clinicians understood their end-of-life wishes despite not having engaged in ACP conversations that would make those wishes known. Improving clinical ACP communication may result in end-of-life treatment that better aligns with patient goals. Index Words: Decision-making, kidney disease, advance directives, caregiving, advance care planning, shared decision-making.
ACP is especially important for older patients with advanced chronic kidney disease CKD because they face difficult decisions about dialysis initiation, often have poor prognoses, and frequently experience cognitive decline, limiting their ability to engage in treatment decision making.
