The following is a summary of “Nephrology providers’ perspective and use of mortality prognostic tools in dialysis patients,” published in the November 2024 issue of Nephrology by Bergeron et al.
Mortality tools support care decisions but are often unused in kidney failure.
Researchers conducted a retrospective study to assess nephrology providers’ practices and barriers to using mortality prognostic tools.
They interviewed 8 physicians and 2 nurse practitioners at an academic medical center using semi-structured questions on mortality prognostic tools. Then, 2 independent reviewers identified key themes using grounded theory. About 3 6-month mortality tools were applied to 279 patients receiving dialysis, with C statistics calculated via logistic regression and receiver operating characteristic (ROC) analysis. Providers then reviewed the tools’ performance in their patient population, and perspectives were reassessed to evaluate any attitude changes.
The results showed that nephrology providers did not use mortality prognostic tools due to concerns about generalizability, trust in clinical judgment, time constraints, and lack of knowledge. Even after reviewing the tools’ performance, providers acknowledged their validity but remained reluctant to adopt them, preferring clinical gestalt for individual patient prognostication. They believed the tools were useful for populations but not for tailoring care to individual patients.
Investigators found that despite the availability of validated prognostic tools, nephrology providers did not incorporate them into routine practice, even after education. Alternative strategies should be explored to improve prognostication in shared decision-making for patients receiving dialysis.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03861-y
