Assessment of self-reported prognostic expectations of people undergoing dialysis: United States Renal Data System Study of Treatment Preferences (USTATE)
JAMA Oct 17, 2019
O’Hare AM, Tamura MK, Lavallee DC, et al. - Through a cross-sectional survey study of 996 individuals who were getting maintenance dialysis at nonprofit facilities in two US metropolitan areas (Seattle, Washington, and Nashville, Tennessee) between April 2015 and October 2018, experts intended to know the prognostic expectations of individuals who were undergoing dialysis and how these associated with care planning, goals, and preferences. By comparison, 185,427 common US in-center individuals who underwent hemodialysis expired within 5 years, 58,437 within 5 to 10 years, and 63,738 lived for more than 10 years. Survey respondents with a prognostic expectation of more than 10 years (vs < 5 years) were less inclined to notify documentation of a surrogate decision-maker and treatment preferences and to considerable support over life extension and were more inclined to want cardiopulmonary resuscitation and mechanical ventilation, in analyses adjusted for individuals' features. The respondents who stated that they were not sure about prognosis had comparable relationships. Thus, it was discovered that in individuals undergoing dialysis, uncertain and overly confident prognostic expectations could restrict the advantage of advance care planning and add to high-intensity end-of-life care.
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