Older patients with advanced chronic kidney disease often do not understand treatment options for renal replacement therapy, conservative kidney management, and advance care planning. It is unclear whether both clinicians and patients have similar perspectives on these treatments and end-of-life care. Thus, the aim of this study was to explore clinician and patient/caregiver perceptions of treatments for end-stage renal disease and advance care planning. This was a qualitative interview study of nephrologists (n = 8), primary care physicians (n = 8), patients (n = 10, ≥ 65 years and estimated glomerular filtration rate < 20), and their caregivers (n = 5). Interviews were conducted until thematic saturation was reached. Transcripts were transcribed using TranscribeMe. Using Nvivo 12, we identified key themes via narrative analysis. We identified three key areas in which nephrologists’, primary care physicians’, and patients’ expectations and/or experiences did not align: 1) dialysis discussions; 2) dialysis decision-making; and 3) processes of advance care planning. Nephrologist felt most comfortable specifically managing renal disease whereas primary care physicians felt their primary role was to advocate for patients and lead advance care planning discussions. Patients and caregivers had many concerns about the impact of dialysis on their lives and did not fully understand advance care planning. Clinicians’ perspectives were aligned with each other but not with patient/caregivers. Our findings highlight the differences in experiences and expectations between clinicians, patients, and their caregivers regarding treatment decisions and advance care planning. Despite clinician agreement on their responsibilities, patients and caregivers were unclear about several aspects of their care. Further research is needed to test feasible models of patient-centered education and communication to ensure that all stakeholders are informed and feel engaged.

中文翻译：

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照顾患有晚期慢性肾病的老年患者并考虑他们的需求：一项定性研究。


患有晚期慢性肾病的老年患者通常不了解肾脏替代疗法、保守肾脏管理和预先护理计划的治疗选择。目前尚不清楚临床医生和患者对这些治疗和临终关怀是否有相似的看法。因此，本研究的目的是探讨临床医生和患者/护理人员对终末期肾病治疗和预先护理计划的看法。这是一项针对肾病专家 (n = 8)、初级保健医生 (n = 8)、患者（n = 10，≥ 65 岁且估计肾小球滤过率 < 20）及其护理人员 (n = 5) 的定性访谈研究。进行访谈直至主题达到饱和。使用 TranscribeMe 转录文字记录。使用 Nvivo 12，我们通过叙述分析确定了关键主题。我们确定了肾脏病专家、初级保健医生和患者的期望和/或经验不一致的三个关键领域：1）透析讨论； 2）透析决策； 3) 预先护理计划的流程。肾病专家在专门管理肾脏疾病方面感到最舒服，而初级保健医生则认为他们的主要作用是为患者辩护并领导预先护理计划讨论。患者和护理人员对透析对其生活的影响有很多担忧，并且不完全了解预先护理计划。临床医生的观点彼此一致，但与患者/护理人员的观点不一致。我们的研究结果强调了临床医生、患者及其护理人员之间在治疗决策和预先护理计划方面的经验和期望的差异。 尽管临床医生就其职责达成一致，但患者和护理人员对其护理的几个方面仍不清楚。需要进一步的研究来测试以患者为中心的教育和沟通的可行模式，以确保所有利益相关者都了解情况并感到参与。