Serious Illness Treatment Preferences for Older Adults with Advanced CKD

Significance Statement Effective advance care planning is a national priority for nephrologists. Yet, multiple barriers stymie patient–provider communication about treatment goals and patient preferences, including limited provider time and reluctance to initiate these conversations. This study examined a single-item measure eliciting patients’ treatment preference when confronted with a serious illness. This simple measure associated with two validated tools measuring health outcome priorities as well as acceptability of hypothetical end-of-life scenarios, including chronic dialysis. These results suggest that the serious illness treatment preference question is an efficient measure that can serve as an important point of entry for initiating goals-of-care communication and discussing the trade-offs of aggressive treatments ( e.g. , dialysis) with respect to patients’ overarching goals. Background Patient-centered care for older adults with CKD requires communication about patient’s values, goals of care, and treatment preferences. Eliciting this information requires tools that patients understand and that enable effective communication about their care preferences. Methods Nephrology clinic patients age ≥60 years with stage 4 or 5 nondialysis-dependent CKD selected one of four responses to the question, “If you had a serious illness, what would be important to you?” Condensed versions of the options were, “Live as long as possible;” “Try treatments, but do not suffer;” “Focus on comfort;” or “Unsure.” Patients also completed a validated health outcome prioritization tool and an instrument determining the acceptability of end-of-life scenarios. Patient responses to the three tools were compared. Results Of the 382 participants, 35% ( n =134) selected “Try treatments, but do not suffer;” 33% ( n =126) chose “Focus on comfort;” 20% ( n =75) opted for “Live as long as possible;” and 12% ( n =47) selected “Unsure.” Answers were associated with patients’ first health outcome priority and acceptability of end-of-life scenarios. One third of patients with a preference to “Focus on comfort” reported that a life on dialysis would not be worth living compared with 5% of those who chose “Live as long as possible” ( P <0.001). About 90% of patients agreed to share their preferences with their providers. Conclusions Older adults with advanced CKD have diverse treatment preferences and want to share them. A single treatment preference question correlated well with longer, validated health preference tools and may provide a point of entry for discussions about patient’s treatment goals.