Publications by authors named "Catherine R Butler"
Importance: Transplant can be a valuable treatment option for older adults with kidney failure, and recent initiatives encourage more frequent referral to transplant centers. However, the evaluation process can be challenging, and most older adults do not ultimately receive a kidney.
Objective: To elucidate the perspectives and experiences of older adults with advanced kidney disease and their family members regarding the kidney transplant evaluation process.
Article Synopsis
- There's a growing population of older adults with kidney disease, but there's not enough evidence to help improve their clinical care, prompting the KDARC to conduct a study on research priorities in geriatric nephrology.
- The study used a modified Delphi approach involving clinicians and researchers in the US and Canada to gather and prioritize important research topics for better care of older adults with kidney issues.
- Five key research priorities were identified: improving communication about treatment options, enhancing quality of life and symptom management, addressing frailty, tailoring therapies for older adults, and providing caregiver support, all underlined by the importance of health equity and patient-centered care.
Key Points: AKI is common among hospitalized patients. However, the contribution of neighborhood social determinants of health to AKI risk is not known. We found that among 26,769 hospitalized patients, 26% developed AKI.
View Article and Find Full Text PDFAdvocates for improved equity in kidney transplants in the United States have recently focused their efforts on initiatives to increase referral for transplant evaluation. However, because donor kidneys remain scarce, increased referrals are likely to result in an increasing number of patients proceeding through the evaluation process without ultimately receiving a kidney. Unfortunately, the process of referral and evaluation can be highly resource-intensive for patients, families, transplant programs, and payers.
View Article and Find Full Text PDFArticle Synopsis
- Advocacy and policy change are essential for enhancing quality care and support for patients using home dialysis, yet only a small percentage of U.S. patients utilize it despite its benefits.
- System-level issues such as inadequate infrastructure, staffing shortages for education, and physician expertise hinder the growth of home dialysis options.
- The article reviews current trends, defines high-quality care for home dialysis patients, and compares U.S. policies with those in other countries, while suggesting future directions for improvement in care and advocacy initiatives.
Importance: The second year of the COVID-19 pandemic saw periods of dire health care resource limitations in the US, sometimes prompting official declarations of crisis, but little is known about how these conditions were experienced by frontline clinicians.
Objective: To describe the experiences of US clinicians practicing under conditions of extreme resource limitation during the second year of the pandemic.
Design, Setting, And Participants: This qualitative inductive thematic analysis was based on interviews with physicians and nurses providing direct patient care at US health care institutions during the COVID-19 pandemic.
Decisions around initiating and forgoing treatments for kidney failure are complex, and contemporary approaches to medical decision making are designed to uphold patients' own preferences and values when there are multiple clinically reasonable treatment options. When patients do not have cognitive capacity to make their own decisions, these models can be adapted to support the previously expressed preferences of older adults and to promote open futures as autonomous persons for young children. Nonetheless, an autonomy-focused approach to decision making may not align with other overlapping values and needs of these groups.
View Article and Find Full Text PDFImportance: Patients receiving maintenance dialysis experience intensive patterns of end-of-life care that might not be consistent with their values.
Objective: To evaluate the association of patients' health care values with engagement in advance care planning and end-of-life care.
Design, Setting, And Participants: Survey study of patients who received maintenance dialysis between 2015 and 2018 at dialysis centers in the greater metropolitan areas of Seattle, Washington, and Nashville, Tennessee, with longitudinal follow-up of decedents.
Importance: There is increasing recognition of the long-term health effects of SARS-CoV-2 infection (sometimes called long COVID). However, little is yet known about the clinical diagnosis and management of long COVID within health systems.
Objective: To describe dominant themes pertaining to the clinical diagnosis and management of long COVID in the electronic health records (EHRs) of patients with a diagnostic code for this condition (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code U09.
Article Synopsis
- - This study looks at how patients with kidney disease from racial and ethnic minority groups differ in their existential and supportive care needs compared to White patients.
- - The research focuses on the specific challenges and requirements these diverse groups face in managing their health and emotional well-being.
- - The findings aim to highlight disparities and improve care strategies for all patients, ensuring that everyone receives the necessary support tailored to their unique backgrounds.
Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources.
View Article and Find Full Text PDFImportance: Since 2014, when Congress passed the Veterans Access Choice and Accountability (Choice) Act (replaced in 2018 with the more comprehensive Maintaining Internal Systems and Strengthening Integrated Outside Networks [MISSION] Act), the Department of Veterans Affairs (VA) has been paying for US veterans to receive increasing amounts of care in the private sector (non-VA care or VA community care). However, little is known about the implications of these legislative changes for the VA system.
Objective: To describe the implications for the VA system of recent increases in VA-financed non-VA care.
Importance: The COVID-19 pandemic prompted health care institutions worldwide to develop plans for allocation of scarce resources in crisis capacity settings. These plans frequently rely on rapid deployment of institutional triage teams that would be responsible for prioritizing patients to receive scarce resources; however, little is known about how these teams function or how to support team members participating in this unique task.
Objective: To identify themes illuminating triage team members' perspectives and experiences pertaining to the triage process.
Objective: Plans for allocation of scarce life-sustaining resources during the coronavirus disease 2019 (COVID-19) pandemic often include triage teams, but operational details are lacking, including what patient information is needed to make triage decisions.
Methods: A Delphi study among Washington state disaster preparedness experts was performed to develop a list of patient information items needed for triage team decision-making during the COVID-19 pandemic. Experts proposed and rated their agreement with candidate information items during asynchronous Delphi rounds.