title: A communication framework for dialysis decision-making for frail elderly patients.
abstract: Frail elderly patients with advanced kidney disease experience many of the burdens associated with dialysis. Although these patients constitute the fastest-growing population starting dialysis, they often suffer loss of functional status, impaired quality of life, and increased mortality after dialysis initiation. Nephrology clinicians face the challenges of helping patients decide if the potential benefits of dialysis outweigh the risks and preparing such patients for future setbacks. A communication framework for dialysis decision-making that aligns treatment choices with patient goals and values is presented. The role of uncertainty is highlighted, and the concept of a goal-directed care plan is introduced. This plan incorporates a time-limited trial that promotes frequent opportunities for reassessment. Using the communication skills presented, the clinician can prepare and guide patients for the dialysis trajectory as it unfolds.
authors: Section of Palliative Care and Medical Ethics and Renal-Electrolyte Division, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and schelljo@upmc.edu.
authors: Jane O
authors: JO
authors: Schell
authors: Department of Medicine, Nephrology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors: Robert A
authors: RA
authors: Cohen
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D003142:Communication; D003657:Decision Making; D016330:Frail Elderly; D006801:Humans; D008297:Male; D009398:Nephrology / Q000379:methods*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011788:Quality of Life; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
keywords: CKD; children; pediatric nephrology