Older adults with advanced chronic kidney disease and access to palliative care
Bibliographic record
Abstract
OBJECTIVE: To describe the provision of primary and specialist palliative care for older adults with advanced chronic kidney disease (CKD). DESIGN: Population-based retrospective descriptive cohort study using electronic health records. SETTING: St Michael's Hospital Academic Family Health Team, including 5 clinics and an interdisciplinary home-based outreach team, in Toronto, Ont. PARTICIPANTS: Older adults who are 65 years of age or older with advanced CKD and undergoing community-based nondialysis kidney care between April 1, 2012, and April 1, 2022, with at least 1 year of follow-up. MAIN OUTCOME MEASURES: Prevalence of advance care planning, goals of care (GOC) discussions, access to specialized palliative care, frequency of hospitalizations, places of deaths, and mean survival time. RESULTS: The study included 47 older adults with advanced CKD who were not undergoing dialysis and receiving primary care. Sixty-eight percent were female (n=32), and the mean (SD) age was 81 (8) years. The mean (SD) number of comorbidities was 5 (2). Almost half of the patients (n=22) lived alone. Seventy percent of the cohort (n=33) had a documented substitute decision maker. Approximately one-third of the cohort (n=16) had GOC conversations involving prognosis, hospital transfer, place of death, and treatment goals. Forty-seven percent (n=22) accessed specialist palliative care during follow-up. Seventy-four percent (n=35) had 1 or more hospitalization. Thirty-two percent (n=8) died at home. The mean (SD) survival time was 2 (2) years. CONCLUSION: A palliative approach to care including advance care planning and GOC conversations would be appropriate for older adults with advanced CKD given their high rates of comorbidities, hospitalizations, and mortality. Primary care providers might experience challenges facilitating conversations in this population, highlighting opportunities for enhanced training and point-of-care interventions, and facilitating access to specialist palliative care consultations when appropriate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".