TY - JOUR
T1 - Provider perspectives on treatment decision-making in nephrotic syndrome
AU - Hladunewich, Michelle A.
AU - Beanlands, Heather
AU - Herreshoff, Emily
AU - Troost, Jonathan P.
AU - Trachtman, Maria Maione Howard
AU - Poulton, Caroline
AU - Nachman, Patrick
AU - Modes, Mary Margaret
AU - Hailperin, Marilyn
AU - Pitter, Renee
AU - Gipson, Debbie S.
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Background. Managing patients with nephrotic syndrome (NS) remains difficult for the practicing nephrologist. This often young patient population is faced with a debilitating, relapsing and remitting disease with non-specific treatment options that are often poorly tolerated. Clinicians managing these complex patients must attempt to apply disease-specific evidence while considering the individual patient's clinical and personal situation. Methods. We conducted qualitative interviews to ascertain the provider perspectives of NS, treatment options and factors that influence recommendations for disease management, and administered a survey to assess both facilitators and barriers to the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results. When making treatment recommendations, providers considered characteristics of various treatments such as efficacy, side effects and evaluation of risk versus benefit, taking into account how the specific treatment fit with the individual patient. Time constraints and the complexity of explaining the intricacies of NS were noted as significant barriers to care. Although the availability of guidelines was deemed a facilitator to care, the value of the KDIGO guidelines was limited by the perception of poor quality of evidence. Conclusions. The complexity of NS and the scarcity of robust evidence to support treatment recommendations are common challenges reported by nephrologists. Future development and use of shared learning platforms may support the integration of best available evidence, patient/family preferences and exchange of information at a pace that is unconstrained by the outpatient clinic schedule.
AB - Background. Managing patients with nephrotic syndrome (NS) remains difficult for the practicing nephrologist. This often young patient population is faced with a debilitating, relapsing and remitting disease with non-specific treatment options that are often poorly tolerated. Clinicians managing these complex patients must attempt to apply disease-specific evidence while considering the individual patient's clinical and personal situation. Methods. We conducted qualitative interviews to ascertain the provider perspectives of NS, treatment options and factors that influence recommendations for disease management, and administered a survey to assess both facilitators and barriers to the implementation of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Results. When making treatment recommendations, providers considered characteristics of various treatments such as efficacy, side effects and evaluation of risk versus benefit, taking into account how the specific treatment fit with the individual patient. Time constraints and the complexity of explaining the intricacies of NS were noted as significant barriers to care. Although the availability of guidelines was deemed a facilitator to care, the value of the KDIGO guidelines was limited by the perception of poor quality of evidence. Conclusions. The complexity of NS and the scarcity of robust evidence to support treatment recommendations are common challenges reported by nephrologists. Future development and use of shared learning platforms may support the integration of best available evidence, patient/family preferences and exchange of information at a pace that is unconstrained by the outpatient clinic schedule.
KW - KDIGO guidelines
KW - Learning needs
KW - Nephrotic syndrome
KW - Qualitative approaches
KW - Treatment decision-making
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U2 - 10.1093/ndt/gfw309
DO - 10.1093/ndt/gfw309
M3 - Article
C2 - 28391336
AN - SCOPUS:85030619112
SN - 0931-0509
VL - 32
SP - I106-I114
JO - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress
JF - Proceedings of the European Dialysis and Transplant Association - European Renal Association. European Dialysis and Transplant Association - European Renal Association. Congress
ER -