RATIONALE & OBJECTIVE Elicitation and documentation of patient preferences is at the core of shared decision making and is particularly important among patients with high anticipated mortality. The extent to which older patients with incident kidney failure undertake such discussions with their providers is unknown and its characterization was the focus of this study. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS A random sample of veterans 67 years and older with incident kidney failure receiving care from the US Veterans Health Administration between 2005 and 2010. EXPOSURES Demographic and facility characteristics, as well as predicted 6-month mortality risk after dialysis initiation and documentation of resuscitation preferences. OUTCOMES Documented discussions of dialysis treatment and supportive care. ANALYTICAL APPROACH We reviewed medical records over the 2 years before incident kidney failure and up to 1 year afterward to ascertain the frequency and timing of documented discussions about dialysis treatment, supportive care, and resuscitation. Logistic regression was used to identify factors associated with these documented discussions. RESULTS The cohort of 821 veterans had a mean age of 80.9±7.2 years, and 37.2% had a predicted 6-month mortality risk>20% with dialysis. Documented discussions addressing dialysis treatment and resuscitation were present in 55.6% and 77.1% of patients, respectively. Those addressing supportive care were present in 32.4%. The frequency of documentation varied by mortality risk and whether the patient ultimately started dialysis. In adjusted analyses, the frequency and pattern of documentation were more strongly associated with geographic location and receipt of outpatient nephrology care than with patient demographic or clinical characteristics. LIMITATIONS Documentation may not fully reflect the quality and content of discussions, and generalizability to nonveteran patients is limited. CONCLUSIONS Among older veterans with incident kidney failure, discussions of dialysis treatment are decoupled from other aspects of advance care planning and are suboptimally documented, even among patients at high risk for mortality.

中文翻译：

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肾功能不全的老年退伍军人进行医疗目标讨论的病历文件。

理由和目标对患者偏爱的启发和记录是共同决策的核心，在预期死亡率较高的患者中尤其重要。尚不清楚患有肾功能衰竭的老年患者与其提供者进行此类讨论的程度，其特征是本研究的重点。研究设计回顾性队列研究。机构和参与者2005年至2010年之间，随机从美国退伍军人卫生管理局（US Veterans Health Administration）接受67岁及以上肾功能衰竭的退伍军人的抽样调查。复苏偏好。结果关于透析治疗和支持治疗的文献讨论。分析方法我们回顾了在肾功能衰竭之前2年以及之后1年内的医疗记录，以确定有关透析治疗，支持治疗和复苏的书面讨论的频率和时机。使用逻辑回归分析来确定与这些文献讨论相关的因素。结果该组821名退伍军人的平均年龄为80.9±7.2岁，而37.2％的人预计透析后6个月的死亡风险> 20％。分别有55.6％和77.1％的患者进行了有关透析治疗和复苏的文献讨论。那些支持支持治疗的人群占32.4％。记录的频率随死亡风险以及患者是否最终开始透析而变化。在调整后的分析中，与患者的人口统计学或临床特征相比，记录的频率和方式与地理位置和门诊肾脏病护理的接受程度更紧密相关。局限性文档可能无法完全反映讨论的质量和内容，并且对非经验丰富患者的普遍性受到限制。结论在患有肾功能衰竭的老年退伍军人中，关于透析治疗的讨论与预先护理计划的其他方面脱钩，即使在死亡风险高的患者中，透析治疗的记录也不够理想。而且对非经验丰富的患者的推广性是有限的。结论在患有肾功能衰竭的老年退伍军人中，关于透析治疗的讨论与预先护理计划的其他方面脱钩，即使在死亡风险高的患者中，透析治疗的记录也不够理想。而且对非经验丰富的患者的推广性是有限的。结论在患有肾功能衰竭的老年退伍军人中，关于透析治疗的讨论与预先护理计划的其他方面脱钩，即使在死亡风险高的患者中，透析治疗的记录也不够理想。