Dialysis patients are more optimistic than their physicians regarding their prognosis and transplant candidacy, and their expectations are tied to their treatment preferences, according to a study published online in JAMA Internal Medicine.
Melissa W. Wachterman, MD, MPH, from the Beth Israel Deaconess Medical Center in Boston, and colleagues used medical records to estimate one-year mortality risk among 207 patients who underwent dialysis (Nov. 1, 2010, through Sept. 1, 2011). Interviews with 62 eligible patients (whose predicted one-year mortality, based on validated prognostic tools, was at least 20 percent) were conducted and compared to interviews with their nephrologists.
Patients were significantly more optimistic than their nephrologists about one- and five-year survival and were significantly more likely to think they were transplant candidates. Forty-four percent of patients reporting a 90% chance or greater of being alive at one year preferred care focused on extending life, even if it meant more discomfort, compared with just one patient (9%) among those reporting a lower chance of survival. Compared with 81% who expected to be alive at one year, 93% actually were, although that number decreased to 79% by 17 months and 56% by 23 months.
“Hemodialysis patients are more optimistic about prognosis and transplant candidacy than their nephrologists,” the authors concluded.