Imperial College London
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ProfessorEdwinaBrown

Faculty of Medicine, Department of Immunology and Inflammation

Professor of Renal Medicine
 
 
 
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Contact

 

+44 (0)20 3311 7590e.a.brown

 
 
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Location

 

Renal OfficesHammersmith HouseHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Beckwith:2021:10.1016/j.ekir.2021.02.032,
author = {Beckwith, H and Adwaney, A and Appelbe, M and Gaffney, H and Hill, P and Moabi, D and Prout, V and Salisbury, E and Webster, P and Tomlinson, J and Brown, E},
doi = {10.1016/j.ekir.2021.02.032},
journal = {Kidney International Reports},
pages = {1558--1566},
title = {Perceptions of illness severity, treatment goals and life expectancy: the ePISTLE study},
url = {http://dx.doi.org/10.1016/j.ekir.2021.02.032},
volume = {6},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - IntroductionA better understanding of factors influencing perceived life expectancy (PLE), interactions between patient prognostic beliefs, experiences of illness, and treatment behavior is urgently needed.MethodsCase-notes at 3 hemodialysis units were screened: patients with ≥20% 1-year mortality risk were included. Patients and their health care professionals (HCPs) were invited to complete a structured interview or mixed-methods questionnaire. Four hundred eleven patient notes were screened. Seventy-seven eligible patients were approached and 51 were included.ResultsPatients predicted significantly higher life expectancies than HCPs (P < 0.0001). Documented cognitive impairment, gender, or increasing age did not affect 1- or 5-year PLE. PLE influenced priorities of care: one-fifth of patients who estimated themselves to have >95% 1-year survival preferred “care focusing on relieving pain and discomfort,” compared with nearly three-quarters of those reporting a ≤50% chance of 1-year survival. Twenty of 51 (39%) patients believed transplantation was an option for them, despite only 4 being waitlisted at the time of the interview. Patients who thought they were transplant candidates were significantly more confident they would be alive at 1 and 5 years and to want resuscitation attempted. Cognitive impairment had no effect on perceived transplant candidacy. A high symptom burden was present and underrecognized by HCPs. High symptom burden was associated with significantly lower PLE at both 1 and 5 years, increased anxiety/depression scores, and treatment choices more likely to prioritize relief of suffering.ConclusionThere is a disparity between patient PLE and those of their HCPs. Severity of symptom burden and beliefs regarding PLE or transplant candidacy affect patient treatment preferences.
AU  - Beckwith,H
AU  - Adwaney,A
AU  - Appelbe,M
AU  - Gaffney,H
AU  - Hill,P
AU  - Moabi,D
AU  - Prout,V
AU  - Salisbury,E
AU  - Webster,P
AU  - Tomlinson,J
AU  - Brown,E
DO  - 10.1016/j.ekir.2021.02.032
EP  - 1566
PY  - 2021///
SN  - 2468-0249
SP  - 1558
TI  - Perceptions of illness severity, treatment goals and life expectancy: the ePISTLE study
T2  - Kidney International Reports
UR  - http://dx.doi.org/10.1016/j.ekir.2021.02.032
UR  - https://www.sciencedirect.com/science/article/pii/S2468024921001030?via%3Dihub
UR  - http://hdl.handle.net/10044/1/88019
VL  - 6
ER  -
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