Choice & Decision Making in the Older (> 75 yrs) for dialysis

Dear Colleagues - Greetings from a wet & cold UK!

This looks like a great forum to share my thoughts and ideas and hopefully build up some international networks with fellow renal professionals. I have been in Nephrology Nursing for nearly 20 years and currently work in a University in the UK teaching Nephrology. Additionally I am currently undertaking a PhD which is focused upon the experiences of choice & decision making in the older patient i.e. those aged 75 yrs and above.

As we all know globally the older patient group will remain the largest group of patients in many of our units and therefore we need to look at innovative and creative means to ensure that real choice is offered regarding suitable dialysis modalities. It would appear to date that there has been very little empirical work which specifically examines the experiences of this unique group of patients when faced with treatment choices. (If you know of any current studies or useful literature on this topic please let me know)

Also more concerning is how current educational approaches have been developed to take into account the real impact of ageing on learning and how this influences patient understanding of their condition. I know there has been some work (Systematic Review of Decisional Aids - See Annette O’Connor - Cochrane Reviews at the University of York UK) but these rarely consider the older patient.

Most of the generic literature that I have come across so far stresses the importance of patients and in some cases their families being fully informed of the risks, hazards & benefits of various treatment choices. Generally it would appear in the UK that providing this level of information is not standard practice which is a worry - when patients are not in fully receipt of the information is a real choice being made.

I would like to hear from my fellow renal colleagues what their thoughts are regarding what you see as the issues in promoting informed choice & decision making in those aged 75yrs & above. I would also be keen to hear about how in your own units you actually support this in practice and specifically what educational strategies you employ.

I apologise for this rather long message but hope you get the essence of what I am trying to say?

My best wishes and look forward to hearing from you

John Sedgewick
MSc (Nurs), MSc (Research), BSc (Hons) Nurs, RN, RMN, Dip.Nurs, Renal Cert, Cert.ED, RNT
Principal Lecturer (Nephrology)
& Programmes Director Multi-Professional Programmes
School of Health & Social Care
University of Teesside
Durham Tees Valley

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