VIEWS: 20 PAGES: 4 CATEGORY: Medicine POSTED ON: 7/14/2010
The authors of the paper are Dr. Stephen M. Wittenberg from the Department of Medicine and Dr. Lewis M. Cohen from the Department of Psychiatry - both are from Baystate Medical Centre, Springfield, Massachusetts, U.S.A. The authors draw our attention to American statistics, which indicate that 85,000 patients with end stage renal disease (ESRD) die every year, yet nephrologists commonly avoid discussions around prognosis. The authors of the study pointed out that having ESRD patients assess their own health condition might also be an independent predictor of death because these patients have insight into their quality of life, self-management behaviours and treatment compliance/non-compliance.
Research review Estimating prognosis Copyright 2010 Canadian Association of Nephrology Nurses and Technologists these matters” (p. 165). In another help patients and their families make Wittenberg, S.M., & Cohen, L.M. survey undertaken by Fine, Fontaine, informed decisions about their care and (2009). Estimating prognosis in Kraushar, and Rich (2005) of 100 future goals. With the lack of training in end-stage renal disease. Progress in patients with chronic kidney disease, the communication in end-of-life care Palliative Care, 17(4), 165–169. researchers found that 97% of within the nephrology fellowship respondents wanted prognostic programs, it is not shocking that these Reviewed by Kalli Stilos, RN, MScN, information and more than 50% of the discussions do not take place between CHPCN(C), Advanced Practice Nurse, respondents stated they needed to know physicians, patients and their families. Palliative Care Consult Team, their prognosis on dialysis. Large Giving bad news to patients and their Sunnybrook Health Science Centre, percentages wanted this information so families in a patient-centred and Toronto, ON they were “better prepared to accept culturally sensitive approach is not The author’s purpose for this review what happens in the future” (p. 165) and common to physicians’ practice. article was to explore estimating believed that their nephrologists should Discussions like these need time, a quiet, prognosis within the context of end stage volunteer that information and that they private and comfortable place for the renal disease (ESRD); to present factors should not have to be prompted for it. patient and their loved ones. To address that prevent physicians from discussing Additional studies are cited to support this issue, the nephrology community is this issue; and to review existing methods this point. starting to include the topic of used for formulating a prognosis. The The Renal Physicians Association and communication in their curriculum. authors of the paper are Dr. Stephen M. American Society of Nephrology clinical A concern for nephrologists is that by Wittenberg from the Department of practice guidelines (2000) on initiation having discussions around prognosis, it Medicine and Dr. Lewis M. Cohen from and withdrawal of dialysis suggest the may demoralize patients and their loved the Department of Psychiatry—both are issue of prognosis be discussed with ones, causing them psychological from Baystate Medical Centre, patients, yet it is an area nephrologists distress. This review article references Springﬁeld, Massachusetts, U.S.A. fail to articulate. Reinforcing the need to several studies that support open, The authors draw our attention to have these discussions is the statistic that ongoing dialogue about poor prognosis American statistics, which indicate that “one- and ﬁve-year mortality rates in as a key factor in strengthening the 85,000 patients with end stage renal ESRD are 25% and 60% respectively— patient-physician relationship and also disease (ESRD) die every year, yet considerably higher than that of most to enhance patients’ hope by shaping nephrologists commonly avoid cancers” (p. 168). It has been future decisions that are in line with discussions around prognosis. Research recommended that further research be their goals and values. has found that dialysis patients want to performed on estimating the prognosis of Another reason why nephrologists know this pertinent information. In renal patients. forgo discussions about prognosis is the 2008, the National Kidney Foundation Many factors hinder end-of-life lack of prognostic tools available that are (Weiner, 2008) conducted an “online discussions. The review article focuses on generalizable, precise and useful. The survey of 182 dialysis patients and found three that are largely responsible for non- Surprise Question (SQ) is an instrument that: a) 5
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