Experience of Older Adults and Their Family Members in the Kidney Transplant Evaluation
Notice bibliographique
Résumé
Importance: Transplant can be a valuable treatment option for older adults with kidney failure, and recent initiatives encourage more frequent referral to transplant centers. However, the evaluation process can be challenging, and most older adults do not ultimately receive a kidney. Objective: To elucidate the perspectives and experiences of older adults with advanced kidney disease and their family members regarding the kidney transplant evaluation process. Design, Setting, and Participants: This qualitative study, conducted between December 19, 2022, and February 5, 2024, included adults aged 65 years or older with advanced kidney disease (estimated glomerular filtration rate ≤20 mL/min/1.73 m2, receiving dialysis, or with a functioning kidney transplant) and their family members in Seattle, Washington. Main Outcomes and Measures: Perspectives and experiences of patients and family members, identified through inductive thematic analysis of semi-structured interviews. Results: A total of 26 older adults (16 [61.5%] men; median age, 68 years [range, 65-74 years]) with advanced kidney disease and 7 of their family members (4 [57.1%] women; median age, 65 years [range, 36-75 years]) were interviewed. Three dominant themes pertaining to the kidney transplant evaluation process were identified: (1) committed to transplant, (2) a complex and protracted process, and (3) responsibility without power. Because receiving a kidney was such an important priority, most participants were willing to engage in what could be a demanding process of testing and treatment narrowly focused on this future goal. However, the transplant evaluation could be lengthy, demanding, opaque, and fragmented, and patients often put other aspects of their lives on hold while awaiting an uncertain result. Patients and families often felt personally responsible for navigating and completing the transplant evaluation despite having little power to shape this process. Feeling responsible for the continued progress of a high-stakes evaluation process while remaining dependent on clinical teams and family members for support could strain relationships. Conclusions and Relevance: This qualitative study found that older adults with advanced kidney disease and their family members were highly motivated to receive a kidney transplant but engagement in an evaluation process, over which they had little control, could have far-reaching implications for patients and families. These findings underline the importance of making the transplant evaluation process more transparent and person centered and of helping patients and families who are contemplating or engaged in the process to understand what to expect.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».