DIALYSIS OR PALLIATIVE CARE?: WHAT DO HEALTH CARE PROFESSIONALS PREFER FOR THEMSELVES AND FOR THEIR PATIENTS?

   Purpose: The goal of this study is to understand factors that influence treatment recommendations of health care professionals (HCPs) for dialysis versus non-dialysis conservative management (CM) for elderly End Stage Renal Disease (ESRD) patients and to contrast these results to what providers would choose for themselves. We hypothesize that HCPs are more likely to recommend CM (over dialysis) for older patients, for females (because males as primary income earners might be given priority), for those with lower incomes, and for those with complicated comorbidities. We also hypothesize HCPs are more likely to choose CM for themselves than for patients, all else equal.

   Method(s): A questionnaire was administered at the 9^th Asian Forum of Chronic Kidney Disease Initiative in May 2015 to 203 HCPs who treat or counsel ESRD patients in Indonesia. The questionnaire investigated HCPs’ preferred recommendations via a series of vignettes describing hypothetical patients with varying age (65, 75 and 85 years), comorbidities (diabetes, diabetes with congestive heart failure and advanced cancer), gender and socio-economic status (poor, middle-class, wealthy). HCPs were also asked to choose a preferred treatment for themselves in a series of hypothetical scenarios describing the age and comorbidities present when diagnosed with ESRD.

   Result(s): As predicted, the likelihood of HCPs recommending CM over dialysis was greater for older patients, for poorer patients, and when the hypothetical patient was diagnosed with advanced cancer (compared to diabetes or heart failure). Gender did not have a significant influence on treatment recommendations. Treatment recommendations varied widely for any given patient profile except when the hypothetical patient was 85 years old or had advanced cancer, in which case the preference was to recommend CM in the vast majority of cases. Treatment choices for self were more homogenous and dialysis was chosen more than CM. HCPs also tended to choose CM less for themselves than for patients. CM was recommended 57% of the time for patients vs. 38% for themselves.

   Conclusion(s): Results show that HCPs treatment recommendations were affected not only by patient comorbidities and age, but also patient socio-economic status.  Efforts should be made to better understand the variation between HCPs in treatment recommendations for similar patient profiles; and also the difference between HCPs recommendations for patients and their own preferences.