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A Discrete Choice Experiment Pilot Study: Understanding Patient Preferences for In-centre Hemodialysis

  • Author / Creator
    Stevenson, Jarom G
  • Background:
    End-stage kidney disease (ESKD) is the failure of functioning kidneys such that they no longer have the capacity to sustain life without intervention. While the incidence of ESKD has remained generally stable across all ages of Canadians since 2000, the prevalence of ESKD has been increasing. Kidney replacement therapy is required to sustain life, and options include dialysis or kidney transplant. Available dialysis modalities include hemodialysis (HD) and peritoneal dialysis (PD). HD is a procedure that filters toxins and solutes from blood through an artificial semipermeable membrane. PD is a procedure that utilizes the semipermeable peritoneal membrane in the abdominal cavity to remove toxins and solutes by regularly filling and draining the cavity with a dialysis solution. The majority of dialysis patients are treated with in-centre HD, which requires three to four hour HD treatments in a hemodialysis unit three times a week, imposing a significant burden of illness due to treatment time. The current prescription for hemodialysis has remained the same for all patients requiring initiation of kidney replacement therapy since its inception in 1985. Patient preference, in conjunction with the understanding that residual kidney function is dynamic has resulted in increasing interest in individualization of dialysis dosage. The individualized prescription often takes the form of an alternative dialysis dose by means of reduced duration, frequency, intensity of flow rates, as well as lifestyle modifications, including diet and fluid restriction. The purpose of this research is to determine and quantify patient preferences with respect to modifiable attributes of dialysis treatment.

    Methods:
    The study employed a qualitative description methodology which identified themes considered important to HD patients. The identified themes were used as attributes and assigned levels to construct a discrete choice experiment (DCE) pilot study to quantify patients' stated preferences of the attributes associated with dialysis in a binary option forced-choice survey.
    Results:
    In the qualitative study, eight people with ESKD participated in virtual interviews. Analysis of the semi structured interview data identified five main themes regarding patient preferences with respect to treatment: time on dialysis, recovery time post dialysis, schedule, diet restriction, and fluid restriction.
    In the DCE, 20 kidney disease patients with a median age of 61 years (range 33-81), and a median dialysis treatment duration of 12 months (range 3-360) were presented a discrete choice experiment pilot study. Overall, 55% (12/20) chose their current treatment prescription and recovery period over the presented alternative dialysis treatment options. Participants choosing alternative treatment options preferred fewer weekly treatments of longer duration, increased flexibility in the choice of dialysis days, and preferred no further fluid restrictions or food restrictions. When comparing participants who picked the alternative treatment to participants who exclusively selected their current dialysis treatment, participants who picked alternative dialysis treatments were typically younger (median age 57 vs 63.5), more likely to drive themselves to dialysis (75% vs 25%), less likely to be retired (50% vs 67%), and less likely to have someone helping them manage their health at home (50% vs 75%).

    Conclusion:
    Inclusion of patient preferences concerning dialysis treatment prescriptions should be more thoroughly considered when making treatment decisions. This individualization of prescriptions should specifically aim to minimize fluid and food restrictions, while increasing schedule flexibility. These changes could be managed by altering dialysis duration and the number of treatments each week to suite specific patient preferences while balancing dialysis requirements. This approach is likely to benefit the health care system, patients, and providers by potentially decreasing costs to the system, incorporating patient preferences, and providing additional prescription options for health care providers to offer dialysis patients. This research highlights the need for increased patient preference consultation in dialysis prescriptions, and provides a foundation to continue quantifying patient preferences with respect to in-centre HD, as there is a range of patient preferences that deviate from the traditional HD prescription.

  • Subjects / Keywords
  • Graduation date
    Fall 2021
  • Type of Item
    Thesis
  • Degree
    Master of Science
  • DOI
    https://doi.org/10.7939/r3-sq5t-5165
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.