title: Supportive Care: Time to Change Our Prognostic Tools and Their Use in CKD.
abstract: In using a patient-centered approach, neither a clinician nor a prognostic score can predict with absolute certainty how well a patient will do or how long he will live; however, validated prognostic scores may improve accuracy of prognostic estimates, thereby enhancing the ability of the clinicians to appreciate the individual burden of disease and the prognosis of their patients and inform them accordingly. They may also facilitate nephrologist's recommendation of dialysis services to those who may benefit and proposal of alternative care pathways that might better respect patients' values and goals to those who are unlikely to benefit. The purpose of this article is to discuss the use as well as the limits and deficiencies of currently available prognostic tools. It will describe new predictors that could be integrated in future scores and the role of patients' priorities in development of new scores. Delivering patient-centered care requires an understanding of patients' priorities that are important and relevant to them. Because of limits of available scores, the contribution of new prognostic tools with specific markers of the trajectories for patients with CKD and patients' health reports should be evaluated in relation to their transportability to different clinical and cultural contexts and their potential for integration into the decision-making processes. The benefit of their use then needs to be quantified in clinical practice by outcome studies including health-related quality of life, patient and caregiver satisfaction, or utility for improving clinical management pathways and tailoring individualized patient-centered strategies of care. Future research also needs to incorporate qualitative methods involving patients and their caregivers to better understand the barriers and facilitators to use of these tools in the clinical setting. Information given to patients should be supported by a more realistic approach to what dialysis is likely to entail for the individual patient in terms of likely quality and quantity of life according to the patient's values and goals and not just the possibility of life prolongation.
authors: French End-Stage Renal Disease Registry Renal Epidemiology and Information Network, Agence de la Biomédecine, St. Denis La Plaine, France.
authors: Cécile
authors: C
authors: Couchoud
authors: Departments of Community Health Sciences and.|Medicine, University of Calgary, Calgary, Alberta, Canada.
authors: Brenda
authors: B
authors: Hemmelgarn
authors: Renal Research Institute, New York, New York.|Nephrology Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Peter
authors: P
authors: Kotanko
authors: Division of Nephrology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts.
authors: Michael J
authors: MJ
authors: Germain
authors: Service de Néphrologie-Suppélance rénale, Hôpital Caremeau, Centre Hospitalo-universitaire Nîmes, Nîmes France.|Equipe d'accueil 2415, Biostatistique, Epidémiologie et Santé Publique, Institut Universitaire de Recherche Clinique, Université de Montpellier, Montpellier, France; and.
authors: Olivier
authors: O
authors: Moranne
authors: Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Sara N
authors: SN
authors: Davison
mesh_terms: D015415:Biomarkers; D003661:Decision Support Techniques; D006305:Health Status Indicators; D006801:Humans; D009398:Nephrology / Q000379:methods*; D057240:Patient Preference; D018802:Patient-Centered Care; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*
chemical_list: D015415:Biomarkers
keywords: Caregivers; Decision Making; Epidemiology and outcomes; Humans; Patient-Centered Care; Personal Satisfaction; Prognosis; chronic kidney disease; quality of life; renal dialysis; supportive care; survival