Edlyn G F Tan1, Irene Teo2, Eric A Finkelstein2, Chan C Meng3. 1. Doctor of Medicine (M.D.) Programme, Duke-NUS Medical School, Singapore. 2. Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore. 3. Department of Renal Medicine, Singapore General Hospital, Singapore.
Abstract
AIMS: In Singapore, most elderly end-stage renal disease (ESRD) patients choose dialysis over palliative management. However, dialysis may not be the optimal treatment option given only moderate survival benefits and high costs and treatment burden compared to non-dialysis management. Elderly patients may therefore come to regret this decision. This study investigated: (i) extent of patients' decision regret after starting dialysis, and (ii) potentially modifiable predictors of regret: satisfaction with chronic kidney disease education, decisional conflict, and decision-making involvement. METHODS: The present study was a cross-sectional study of 103 dialysis patients above 70 years of age, surveyed at Singapore General Hospital's renal medicine clinics between March and June 2017. Participants reported their levels of decision regret on the Decision Regret Scale (DRS), retrospective decisional conflict on the Decisional Conflict Scale, information satisfaction, and decision-making involvement. RESULTS: In total, 81% of participants reported no decision regret (DRS score < 50), 11% ambivalence (DRS = 50), and 8% regret (DRS >50). In individual DRS items, 19% felt dialysis had done them harm and 16% would not make the same decision again. In multivariable analyses, lower information satisfaction [b = -0.07 (95% CI: -0.13, -0.01)] and decisional conflict [b = 0.004 (95% CI: 0.002, 0.006)] were significantly associated with decision regret. CONCLUSION: Although the majority of elderly dialysis patients were comfortable with their decision to start dialysis, a proportion was ambivalent or regretted this choice. Regret was more likely among those who experienced decisional conflict and/or expressed poorer information satisfaction. Healthcare professionals should recognize these risk factors and take steps to minimize chances of regret among this population subset.
AIMS: In Singapore, most elderly end-stage renal disease (ESRD) patients choose dialysis over palliative management. However, dialysis may not be the optimal treatment option given only moderate survival benefits and high costs and treatment burden compared to non-dialysis management. Elderly patients may therefore come to regret this decision. This study investigated: (i) extent of patients' decision regret after starting dialysis, and (ii) potentially modifiable predictors of regret: satisfaction with chronic kidney disease education, decisional conflict, and decision-making involvement. METHODS: The present study was a cross-sectional study of 103 dialysis patients above 70 years of age, surveyed at Singapore General Hospital's renal medicine clinics between March and June 2017. Participants reported their levels of decision regret on the Decision Regret Scale (DRS), retrospective decisional conflict on the Decisional Conflict Scale, information satisfaction, and decision-making involvement. RESULTS: In total, 81% of participants reported no decision regret (DRS score < 50), 11% ambivalence (DRS = 50), and 8% regret (DRS >50). In individual DRS items, 19% felt dialysis had done them harm and 16% would not make the same decision again. In multivariable analyses, lower information satisfaction [b = -0.07 (95% CI: -0.13, -0.01)] and decisional conflict [b = 0.004 (95% CI: 0.002, 0.006)] were significantly associated with decision regret. CONCLUSION: Although the majority of elderly dialysis patients were comfortable with their decision to start dialysis, a proportion was ambivalent or regretted this choice. Regret was more likely among those who experienced decisional conflict and/or expressed poorer information satisfaction. Healthcare professionals should recognize these risk factors and take steps to minimize chances of regret among this population subset.
Authors: Fahad Saeed; Susan A Ladwig; Ronald M Epstein; Rebeca D Monk; Paul R Duberstein Journal: Clin J Am Soc Nephrol Date: 2020-06-04 Impact factor: 8.237
Authors: Lindsay A Hampson; Anne M Suskind; Benjamin N Breyer; Matthew R Cooperberg; Rebecca L Sudore; Salomeh Keyhani; I Elaine Allen; Louise C Walter Journal: J Urol Date: 2021-12-02 Impact factor: 7.450
Authors: Emeline Han; Victoria Haldane; Joel Jun Kai Koh; Rina Yu Chin Quek; Semra Ozdemir; Eric Andrew Finkelstein; Tazeen Hasan Jafar; Hui-Lin Choong; Sheryl Gan; Lydia W W Lim; Farah Shiraz; Helena Legido-Quigley Journal: Health Expect Date: 2019-08-16 Impact factor: 3.377
Authors: Rajesh Raj; Srivathsan Thiruvengadam; Kiran Deep Kaur Ahuja; Mai Frandsen; Matthew Jose Journal: BMJ Open Date: 2019-11-24 Impact factor: 2.692
Authors: Nicole DePasquale; Jamie A Green; Patti L Ephraim; Sarah Morton; Sarah B Peskoe; Clemontina A Davenport; Dinushika Mohottige; Lisa McElroy; Tara S Strigo; Felicia Hill-Briggs; Teri Browne; Jonathan Wilson; LaPricia Lewis-Boyer; Ashley N Cabacungan; L Ebony Boulware Journal: Kidney Med Date: 2022-08-04
Authors: Fahad Saeed; Muhammad Sardar; Khalid Rasheed; Raza Naseer; Ronald M Epstein; Sara N Davison; Muhammad Mujtaba; Kevin A Fiscella Journal: J Pain Symptom Manage Date: 2020-03-20 Impact factor: 3.612