title: Provider Knowledge, Attitudes, and Practices Surrounding Conservative Management for Patients with Advanced CKD.
abstract: Despite the potential benefits of conservative management, providers rarely discuss it as a viable treatment option for patients with advanced CKD. This survey was to describe the knowledge, attitudes, and practices of nephrologists and primary care providers regarding conservative management for patients with advanced CKD in the United States.
  
  
  
  We developed a questionnaire on the basis of a literature review to include items assessing knowledge, attitudes, and self-reported practices of conservative management for patients with advanced CKD. Potential participants were identified using the American Medical Association Physician Masterfile. We then conducted a web-based survey between April and May of 2015.
  
  
  
  In total, 431 (67.6% nephrologists and 32.4% primary care providers) providers completed the survey for a crude response rate of 2.7%. The respondents were generally white, men, and in their 30s and 40s. Most primary care provider (83.5%) and nephrology (78.2%) respondents reported that they were likely to discuss conservative management with their older patients with advanced CKD. Self-reported number of patients managed conservatively was >11 patients for 30.6% of nephrologists and 49.2% of primary care providers. Nephrologists were more likely to endorse difficulty determining whether a patient with CKD would benefit from conservative management (52.8% versus 36.2% of primary care providers), whereas primary care providers were more likely to endorse limited information on effectiveness (49.6% versus 24.5% of nephrologists) and difficulty determining eligibility for conservative management (42.5% versus 14.3% of nephrologists). There were also significant differences in knowledge between the groups, with primary care providers reporting more uncertainty about relative survival rates with conservative management compared with different patient groups.
  
  
  
  Both nephrologists and primary care providers reported being comfortable with discussing conservative management with their patients. However, both provider groups identified lack of United States data on outcomes of conservative management and characteristics of patients who would benefit from conservative management as barriers to recommending conservative management in practice.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Sanah
authors.initials: S
authors.lastname: Parvez
authors.affiliation: Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.|Vanderbilt Center for Kidney Disease, Nashville, Tennessee; and.
authors.forename: Khaled
authors.initials: K
authors.lastname: Abdel-Kader
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: V Shane
authors.initials: VS
authors.lastname: Pankratz
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Song
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000706:statistics & numerical data*; D000072700:Conservative Treatment / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000706:statistics & numerical data*; D010358:Patient Participation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: attitude; chronic kidney disease; geriatric nephrology; hemodialysis; humans; knowledge; quality of life; renal insufficiency, chronic; surveys and questionnaires; survival