Rationale & Objective
Decision making for the treatment of kidney failure in older adults should incorporate patient preferences. This discrete choice experiment (DCE) identified the health outcome preferences of older patients with chronic kidney disease (CKD) who are at elevated risk of kidney failure.
Study Design
DCE questionnaire development and application.
Setting & Participants
Persons aged 65 years and older with CKD stage 4 or 5 treated in an outpatient clinic.
Exposure
Five questionnaire attributes: fatigue, life expectancy, level of independence, hospital admissions, and hospital visits.
Outcome
Patients’ health outcome priorities (relative importance of attributes) and the trade-offs they were willing to make (marginal rates of substitution).
Analytical Approach
DCE design based on qualitative research, literature review, and pilot testing (n = 14). Data were analyzed using a logistic regression analysis, and interactions between age subgroups were explored using logistic regression models.
Results
The questionnaire was completed by 85 patients (mean age 77 years; 65% male). Fatigue had the greatest influence on patients’ choices (relative importance 26%), followed by life expectancy (23%), hospital admissions (20%), level of independence (16%), and hospital visits (15%). To avoid fatigue, patients were willing to accept a 46% decrease in 3-year survival probability, 5 extra hospital admissions per year, or 86 extra hospital visits per year. Among patients aged =85 years, avoiding hospital admissions was the top health outcome priority; among patients aged 65-74 years, it was the lowest-ranked attribute.
Limitations
Participants were required to return the questionnaire independently. Subgroups may have been too small to detect all significant differences.
Conclusions
Fatigue and life expectancy were the top health outcome priorities of older people with advanced CKD. Avoiding hospital admissions was the top priority among the oldest patients. These findings inform the choice of patient-centered outcomes in research and clinical practice for older patients with CKD.
Tessa S Schoot, Janine van Til, C Karin G M Groothuis-Oudshoorn, Carolynn Rombeek, Maurits J F Lusseveld, Rob J van Marum, Luuk B Hilbrands, Angèle P M Kerckhoffs
Disease Category: Kidney disease
Disease Name: Chronic kidney disease
Age Range: 65 - 100
Sex: Either
Nature of Intervention: Any
- Consumers (patients)
- Patient perspectives
- Discrete Choice Experiments