Study finds shortcomings in doctor-patient discussions about transplantation

August 28, 2014, American Society of Nephrology

In a study of dialysis patients, those who reported that they had discussed the option of transplantation with clinicians were more likely to be put on the transplant waiting list; however, clinician-reported discussions of transplantation did not increase patients' likelihood of being waitlisted. The findings, which appear in an upcoming issue of the Journal of the American Society of Nephrology (JASN), indicate that better ways of informing patients about kidney transplantation may be needed.

One of the key principles of informed consent is describing . So when starting someone on , it is imperative to discuss the alternatives to hemodialysis, for example peritoneal dialysis and kidney transplantation. The Centers for Medicare & Medicaid Services (CMS) believe the discussion of is so important that they mandate it. Unfortunately, though, there is no guidance as to what kind of discussion is required.

Dorry Segev, MD, PhD (Johns Hopkins University School of Public Health) and his colleagues asked 388 patients if providers (kidney specialists or dialysis staff) had discussed transplantation with them, and then they looked to see whether the providers reported to CMS that they had discussed transplantation with those patients.

The investigators discovered that in almost one-third of cases, providers reported to CMS that they had discussed transplantation with a particular patient, but the patient said that nobody had discussed it with them. Such discussions were reported by both patient and provider for 56.2% of participants, by provider only for 27.8%, by patient only for 8.3%, and by neither for 7.7%.

The researchers also discovered that patient-reported discussions about transplantation were associated with a nearly 3-fold increased that patients would be listed for transplantation, but provider-reported discussions did not increase a patient's likelihood of being listed. In other words, it didn't matter if the provider reported discussing transplantation with the patient; it was only if the patient reported receiving this information that led to him or her to being referred for and listed for a transplant.

"This is a critical lesson for quality improvement in the care of patients with end-stage kidney disease: it's not enough to ask physicians if they provided information to the patient, but rather we need to be asking the patient, because there is major discordance between patient and provider reports, and only the patient report was associated with the expected clinical behavior," said Dr. Segev.

In an accompanying editorial, Mark Unruh, MD (University of New Mexico School of Medicine) and Mary Amanda Dew, PhD (University of Pittsburgh School of Medicine and Medical Center) noted that that "even the best educational efforts will be for naught if the patient does not take in the information or understand it." They cautioned, however, that the form submitted to CMS has been recognized as providing an important but inexact snapshot of patients with kidney failure and other conditions. They also stressed that providing kidney transplant information likely requires repeated discussions when patients are open and able to receive it.

Explore further: Gender disparities uncovered in desire to receive living donor kidney transplants

More information: The article, entitled "Patient- and Provider-Reported Information about Transplantation and Subsequent Waitlisting," will appear online at jasn.asnjournals.org/ on August 28, 2014.

The editorial, entitled Asking Dialysis Patients About What They Were Told: A New Strategy for Improving Access to Kidney Transplantation?" will appear online on August 28, 2014.

Related Stories

Gender disparities uncovered in desire to receive living donor kidney transplants

August 14, 2014
Among black kidney failure patients undergoing dialysis, women are much less likely than men to want to receive kidney transplants from living donors, despite more offers from family and friends. The findings, which are from ...

Race, insurance status related to likelihood of being assessed for kidney transplantation

July 26, 2012
Young black patients and patients without private health insurance are less likely to be assessed for a kidney transplant when they start dialysis, according to a study appearing in an upcoming issue of the Clinical Journal ...

Kidney transplant patients live longer than those in intensive home hemodialysis

May 22, 2014
A first-ever study from a large Canadian centre found that kidney transplant recipients lived longer and had better treatment success than patients on intensive home hemodialysis, but also had an increased risk of being hospitalized ...

Patient education classes may reduce disparities in kidney transplantation

February 16, 2012
Being educated about your health and your treatment options is a good thing. According to a new study, kidney failure patients who take part in an education program are more likely to get evaluated for a kidney transplant. ...

Researchers address major geographic disparities in access to kidney transplantation

May 29, 2014
There is substantial geographic variation in access to kidney transplantation among the more than 4000 US dialysis facilities that treat patients with kidney failure, with a disproportionate lack of access to those in the ...

Education for kidney failure patients may improve chances living donor transplantation

March 21, 2013
Patients with kidney failure who have greater transplant knowledge and motivation are ultimately more likely to receive a kidney transplant from a living donor, according to a study appearing in an upcoming issue of the Clinical ...

Recommended for you

Cold open water plunge provides instant pain relief

February 12, 2018
A short, sharp, cold water swim may offer an alternative to strong painkillers and physiotherapy to relieve severe persistent pain after surgery, suggest doctors in the journal BMJ Case Reports.

Study spotlights risks in anesthesiologist handoffs

February 9, 2018
Most patients are totally unaware that the anesthesiologist who put them under for surgery might not be the same one who brings them out even though that 'handoff' between the two doctors has been linked to a series of negative ...

One in five older adults experience brain network weakening following knee replacement surgery

February 7, 2018
A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive ...

New algorithm decodes spine oncology treatment

February 6, 2018
Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain.

Patients and doctors often disagree in evaluation of surgical scarring

February 1, 2018
When it comes to the physical scars surgery leaves behind, a new study shows patients and doctors often don't assess their severity the same way. Researchers from the Perelman School of Medicine at the University of Pennsylvania ...

Boosting a key protein to help bones that won't heal

February 1, 2018
When a patient breaks a bone, there's a possibility the fracture won't heal properly or quickly—even with the aid of pins, plates or a cast.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.