Laura J James1,2, Germaine Wong3,2, Jonathan C Craig3,2, Angela Ju3,2, Narelle Williams3,2, Wai H Lim4, Nicholas Cross5, Allison Tong3,2. 1. Sydney School of Public Health, University of Sydney, Sydney, Australia; laura.james@health.nsw.gov.au. 2. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia. 3. Sydney School of Public Health, University of Sydney, Sydney, Australia. 4. Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; and. 5. Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand.
Abstract
BACKGROUND AND OBJECTIVES: Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts. RESULTS: Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity). CONCLUSIONS: Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD.
BACKGROUND AND OBJECTIVES:Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts. RESULTS: Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity). CONCLUSIONS:Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD.
Authors: Germaine Wong; Margaret W Y Li; Kirsten Howard; Danny K Hua; Jeremy R Chapman; Michael Bourke; Robin Turner; Allison Tong; Jonathan C Craig Journal: Nephrol Dial Transplant Date: 2012-11-25 Impact factor: 5.992
Authors: Germaine Wong; Richard L Hope; Kirsten Howard; Jeremy R Chapman; Antoni Castells; Simon D Roger; Michael J Bourke; Petra Macaskill; Robin Turner; Gabrielle Williams; Wai Hon Lim; Charmaine E Lok; Fritz Diekmann; Nicholas B Cross; Shaundeep Sen; Richard D M Allen; Steven J Chadban; Carol A Pollock; Allison Tong; Armando Teixeira-Pinto; Jean Y H Yang; Narelle Williams; Eric Hoi Kit Au; Anh Kieu; Laura James; Jonathan C Craig Journal: J Am Soc Nephrol Date: 2019-04-30 Impact factor: 10.121