Identifying Factors That Influence Physicians’ Recommendations for Dialysis and Conservative Management in Indonesia

Eric A. Finkelstein, Semra Ozdemir, Chetna Malhotra, Tazeen H. Jafar, Hui Lin Choong, Suhardjono

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Introduction For elderly end-stage renal disease (ESRD) patients with multiple comorbidities, dialysis may offer little survival benefit compared to conservative management (CM). Yet, many elderly ESRD patients undergo dialysis, partly due to physicians’ recommendations regarding treatment choice. This study aims to elucidate the factors that influence these recommendations. Methods We surveyed a convenience sample of physicians who attended the 9th Asian Forum of Chronic Kidney Disease Initiative conference. We used vignettes that vary by age and comorbidity status, and asked physicians to recommend dialysis or CM for a hypothetical patient with that profile and to predict survival with both treatment options. We also compared the physician's recommendations to patients for what they would recommend for themselves if they were diagnosed with ESRD. Results On average, physicians believed that dialysis extends life relative to CM. Yet, a large subset believed that CM confers greater survival. Estimates range from 17.3% (for a 65-year-old with diabetes and CHF) to 50% for patients with advanced cancer. Results further reveal high discordance regarding treatment recommendations. For a 65-year-old patient with diabetes, 62% recommended dialysis and 38% did not. For advanced cancer, the split was 25% and 75%. Physicians were far more likely to recommend dialysis for themselves than for their patients. Discussion This study suggests that physicians would benefit from a greater understanding of survival benefits of dialysis and CM for elderly patients with different comorbidity profiles. This would allow patients to make more informed decisions.

Original languageEnglish
Pages (from-to)212-218
Number of pages7
JournalKidney International Reports
Volume2
Issue number2
DOIs
Publication statusPublished - 1 Jan 2017

Keywords

  • comorbidities
  • conservative management
  • dialysis
  • end-stage renal disease
  • survival benefits
  • treatment recommendation

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