NDT Advance Access first published online on September 3, 2009
This version published online on September 10, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp430
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Published by Oxford University Press [on behalf of ERA-EDTA] 2009.
Preferences for dialysis withdrawal and engagement in advance care planning within a diverse sample of dialysis patients
1 Division of Nephrology, Center for Primary Care and Outcomes Research, Stanford University School of Medicine 2 VA Palo Alto Health Care System Geriatrics Research Education & Clinical Center, Palo Alto 3 Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA
Correspondence and offprint requests to: Manjula Kurella Tamura; E-mail: mktamura{at}stanford.edu
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Abstract |
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Background and objectives. Rates of dialysis withdrawal are higher among the elderly and lower among Blacks, yet it is unknown whether preferences for withdrawal and engagement in advance care planning also vary by age and race or ethnicity.
Design, setting, participants and methods. We recruited 61 participants from two dialysis clinics to complete questionnaires regarding dialysis withdrawal preferences in five different health states. Engagement in advance care planning (end-of-life discussions), completion of advance directives and ‘do not resuscitate’ or ‘do not intubate’ (DNR/DNI) orders were ascertained by a questionnaire and from dialysis unit records.
Results. The mean age was 62 ± 15 years; 38% were Black, 11% were Latino, 34% were White and 16% of participants were Asian. Blacks were less likely to prefer dialysis withdrawal as compared with Whites (odds ratio 0.16, 95% confidence interval 0.03–0.88) and other race/ethnicity groups, and this difference was not explained by age, education, comorbidity and other confounders. In contrast, older age was not associated with preferences for withdrawal. Rates of engagement in end-of-life discussions were higher than for documentation of advance care planning for all age and most race/ethnicity groups. Although younger participants and minorities were generally less likely to document treatment preferences as compared with older patients and Whites, they were not less likely to engage in end-of-life discussions.
Conclusions. Preferences for withdrawal vary by race/ ethnicity, whereas the pattern of engagement in advance care planning varies by age and race/ethnicity. Knowledge of these differences may be useful for improving communication about end-of-life preferences and in implementing effective advance care planning strategies among diverse haemodialysis patients.
Keywords: advance care planning; dialysis withdrawal; elderly; race; treatment preferences
Received for publication: 2. 6.09
Accepted in revised form: 31. 7.09