Patients undergoing regular dialysis have overly optimistic expectations of their prognosis, according to a study in JAMA Internal Medicine.
The cross-sectional survey study included 996 patients receiving regular dialysis at 31 nonprofit facilities in two US metropolitan areas (Seattle and Nashville). The main outcome of interest was response to the question: “How long would you guess people your age with similar health conditions usually live?” Responses were classified as less than 5 years, 5 to 10 years, more than 10 years, or “not sure.”
Patients’ expectations of survival were compared with those of a cohort of more than 307,000 patients receiving in-center dialysis, drawn from the US Renal Data System. The survey also asked about documented preferences related to end-of-life care.
The survey response rate was 69.5%. The patients’ mean age was 62.7 years; 56% were men, 55% were white, 38% were black, and 16% were Hispanic. Sixty percent of patients died within 5 years and 19% within 5 to 10 years, while 21% survived for more than 10 years. Those figures contrasted with the survey, in which the selected prognosis was less than 5 years for 11% of patients, 5 to 10 years for 15%, and more than 10 years for 33%. Forty percent were unsure of expected survival.
On adjusted analysis, patients with expected survival of more than 10 years were less likely to have documentation of a surrogate decision-maker or treatment preferences, and more likely to desire cardiopulmonary resuscitation and mechanical ventilation. Patients who were unsure of their prognosis had a similar pattern of associations.
Patients receiving dialysis have limited life expectancy, but there are few data on their expectations of prognosis. This survey study suggests that a large majority of dialysis patients either have overly optimistic expectations or are unsure of their prognosis. The researchers conclude, “Further studies are needed to determine whether interventions to raise prognostic awareness can shape treatment preferences, values, quality of life, and preparedness for end-of-life care in this population” [O’Hare AM, et al. Assessment of self-reported prognostic expectations of people undergoing dialysis: United States Renal Data System Study of Treatment Preferences (USTATE). JAMA Intern Med DOI:10.1001/jamainternmed.2019.2879].