Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study

Carlijn G N Voorend,Simon P Mooijaart,Noeleen C Berkhout-Byrne,Willem Jan W Bos,Marjolijn Van Buren,Yvette Meuleman

doi:10.1186/s12882-020-02206-9

Carlijn G N Voorend, Simon P Mooijaart + Show 4 more

Open Access

https://doi.org/10.1186/s12882-020-02206-9

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Abstract

BackgroundOlder patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. Despite guideline recommendations, geriatric assessment is not part of standard clinical care, resulting in a missed opportunity to enhance (clinical) outcomes including quality of life in these patients. To develop routine geriatric assessment programs for patients approaching ESKD, it is crucial to understand patients’ and professionals’ experiences with and perspectives about the benefits, facilitators and barriers for geriatric assessment.MethodsIn this qualitative study, semi-structured focus group discussions were conducted with ESKD patients, caregivers and professionals. Participants were purposively sampled from three Dutch hospital-based study- and routine care initiatives involving geriatric assessment for (pre-)ESKD care. Transcripts were analysed inductively using thematic analysis.ResultsIn six focus-groups, participants (n = 47) demonstrated four major themes: (1) Perceived characteristics of the older (pre)ESKD patient group. Patients and professionals recognized increased vulnerability and (cognitive) comorbidity, which is often unrelated to calendar age. Both believed that often patients are in need of additional support in various geriatric domains. (2) Experiences with geriatric assessment. Patients regarded the content and the time spent on the geriatric assessment predominantly positive. Professionals emphasized that assessment creates awareness among the whole treatment team for cognitive and social problems, shifting the focus from mainly somatic to multidimensional problems. Outcomes of geriatric assessment were observed to enhance a dialogue on suitability of treatment options, (re)adjust treatment and provide/seek additional (social) support. (3) Barriers and facilitators for implementation of geriatric assessment in routine care. Discussed barriers included lack of communication about goals and interpretation of geriatric assessment, burden for patients, illiteracy, and organizational aspects. Major facilitators are good multidisciplinary cooperation, involvement of geriatrics and multidisciplinary team meetings. (4) Desired characteristics of a suitable geriatric assessment concerned the scope and use of tests and timing of assessment.ConclusionsPatients and professionals were positive about using geriatric assessment in routine nephrology care. Implementation seems achievable, once barriers are overcome and facilitators are endorsed. Geriatric assessment in routine care appears promising to improve (clinical) outcomes in patients approaching ESKD.

Highlights

Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity
Patients and professionals were positive about using geriatric assessment in routine nephrology care
The three different practices included (i) a yearly one-hour geriatric assessment in routine care for patients approaching ESKD performed in a University hospital, (ii) a three-hour geriatric assessment for patients approaching ESKD in a study setting, of which results were used in routine-care [15], and (iii) a single-time point geriatric assessment among patients starting with or withholding from dialysis for study purposes, to be measured in a home-visit [4]

Summary

Introduction

Older patients with end-stage kidney disease (ESKD) often live with unidentified frailty and multimorbidity. In older patients with end stage kidney disease (ESKD) frailty, malnutrition, cognitive impairments, depression and impaired health-related quality of life are highly prevalent [1,2,3] and often underdiagnosed [4, 5]. Short frailty screening tools are insufficiently discriminative for clinical use in ESKD patients [13]. In medical areas such as oncology, acute hospital settings and perioperative care, new models and settings of geriatric assessment are being explored [10], but limited attempts in nephrology are reported [4, 14,15,16,17]. No standardized approach exists and the search for the optimum use of geriatric assessment in routine care of older patients approaching ESKD continues [9]

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