Dataset Information

Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.

ABSTRACT:

Background and objectives

Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD.

Design, setting, participants, & measurements

Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts.

Results

Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity).

Conclusions

Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD.

SUBMITTER: James LJ

PROVIDER: S-EPMC5383392 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.

James Laura J LJ Wong Germaine G Craig Jonathan C JC Ju Angela A Williams Narelle N Lim Wai H WH Cross Nicholas N Tong Allison A

Clinical journal of the American Society of Nephrology : CJASN 20170202 4

<h4>Background and objectives</h4>Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD.<h4>Design, setting, participants, & measurements</h4>Face to face, semistructured interviews were conducted fro ...[more]

PMID: 28153937

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Project description:BackgroundOlder adults with chronic kidney disease (CKD) typically use more than 5 medications and have multiple prescribing physicians. However, little is known about how they prioritize their medical conditions or decide which medications to take.MethodsSemistructured interviews (average length, 40 minutes) with 20 community-dwelling adults with CKD stages 3-5D receiving nephrology care at a tertiary referral center. Respondents were asked about medications, prescribing physicians, and medication-taking behaviors. We performed thematic analysis to explain patients' decisions regarding medication prioritization, understanding, and adherence decisions.ResultsParticipants (age range, 55-84 years; mean, 72 years) used 5-14 prescribed medications, had 2-9 physicians, and had 5-11 comorbid conditions. All had assigned implicit priorities to their medications. Although most expressed the intention to be adherent, many regularly skipped medications they considered less important. Most identified the prescribing physician and indication for each medication, but there often was substantial discordance between beliefs about medications and conventional medical opinion. Respondents prioritized medications based on the salience of the particular condition, perceived effects of the treatment, and barriers (physical, logistic, or financial) to using the prescribed drug. Side effects of medications were common and anxiety provoking, but discussions with the prescribing physician often were delayed or unfulfilling for the patient.ConclusionsPolypharmacy in patients with CKD leads to complex medication choices and adherence behaviors in this population. Most patients we interviewed had beliefs or priorities that were nonconcordant with conventional medical opinion; however, patients rarely discussed these beliefs and priorities or the resultant poor medication adherence with their physicians. Further study is needed to provide quantitative data about the magnitude of adherence barriers. It is likely that more effective communication about medication use could improve patients' health outcomes and reduce potential adverse drug events.

Project description:ObjectiveTo examine the experiences of patients, health professionals and screeners; their interactions with and understandings of diabetic retinopathy screening (DRS); and how these influence uptake.DesignPurposive, qualitative design using multiperspectival, semistructured interviews and thematic analysis.SettingThree UK Screening Programme regions with different service-delivery modes, minority ethnic and deprivation levels across rural, urban and inner-city areas, in general practitioner practices and patients' homes.Participants62 including 38 patients (22 regular-screening attenders, 16 non-regular attenders) and 24 professionals (15 primary care professionals and 9 screeners).ResultsAntecedents to attendance included knowledge about diabetic retinopathy and screening; antecedents to non-attendance included psychological, pragmatic and social factors. Confusion between photographs taken at routine eye tests and DRS photographs was identified. The differing regional invitation methods and screening locations were discussed, with convenience and transport safety being over-riding considerations for patients. Some patients mentioned significant pain and visual disturbance from mydriasis drops as a deterrent to attendance.ConclusionsIn this, the first study to consider multiperspectival experiential accounts, we identified that proactive coordination of care involving patients, primary care and screening programmes, prior to, during and after screening is required. Multiple factors, prior to, during and after screening, are involved in the attendance and non-attendance for DRS. Further research is needed to establish whether patient self-management educational interventions and the pharmacological reformulation of shorter acting mydriasis drops, may improve uptake of DRS. This might, in turn, reduce preventable vision loss and its associated costs to individuals and their families, and to health and social care providers, reducing current inequalities.

Project description:BACKGROUND:Although dialysis may not provide a large survival benefit for older patients with kidney failure, few are informed about conservative management. Barriers and facilitators to discussions about conservative management and nephrologists' decisions to present the option of conservative management may vary within the nephrology provider community. STUDY DESIGN:Interview study of nephrologists. SETTING & PARTICIPANTS:National sample of US nephrologists sampled based on sex, years in practice, practice type, and region. METHODOLOGY:Qualitative semistructured interviews continued until thematic saturation. ANALYTICAL APPROACH:Thematic and narrative analysis of recorded and transcribed interviews. RESULTS:Among 35 semistructured interviews with nephrologists from 18 practices, 37% described routinely discussing conservative management ("early adopters"). 5 themes and related subthemes reflected issues that influence nephrologists' decisions to discuss conservative management and their approaches to these discussions: struggling to define nephrologists' roles (determining treatment, instilling hope, and improving patient symptoms), circumventing end-of-life conversations (contending with prognostic uncertainty, fearing emotional backlash, jeopardizing relationships, and tailoring information), confronting institutional barriers (time constraints, care coordination, incentives for dialysis, and discomfort with varied conservative management approaches), conservative management as "no care," and moral distress. Nephrologists' approaches to conservative management discussions were shaped by perceptions of their roles and by a common view of conservative management as no care. Their willingness to pursue conservative management was influenced by provider- and institutional-level barriers and experiences with older patients who regretted or had been harmed by dialysis (moral distress). Early adopters routinely discussed conservative management as a way of relieving moral distress, whereas others who were more selective in discussing conservative management experienced greater distress. LIMITATIONS:Participants' views are likely most transferable to large academic medical centers, due to oversampling of academic clinicians. CONCLUSIONS:Our findings clarify how moral distress serves as a catalyst for conservative management discussion and highlight points of intervention and mechanisms potentially underlying low conservative management use in the United States.

Dataset Information

Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.

Similar Datasets

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