Obliged to fight? Patient moral processes in the face of poor prognosis cancer.

Objective: Theoretical work suggests that moral psychological processes-those pertaining to the interests or welfare of others-are a key driver of overtreatment at the end of life. We examined patient moral processes and their associations with distress and treatment decision-making.

Method: During structured interviews with 116 patients with advanced cancer and a poor prognosis, Likert scale items were used to operationalize (a) moral emotions: feeling shame and guilt about cancer getting worse, (b) moral motives for cancer treatment: perceiving an obligation to family for continuing potentially nonbeneficial treatments, and (c) moral performance: putting up the appearance of feeling better than how one is really feeling (5-point response scale, ).

Feasibility and Acceptability of a Palliative Care Intervention Among Older or Adults with Advanced CKD and their Caregivers.

Background: In non-nephrology settings, specialty Palliative Care (PC) improves decision-making, patient's quality of life (QoL), advance care planning (ACP), and certain indicators of the quality of end-of-life (EoL) care. This pilot RCT explored the feasibility and acceptability of a PC intervention, CKD-EDU, for older adults ≥75 years with eGFR ≤25 ml/min and their caregivers.

Methods: Participants randomized to the control group received standard nephrology care and routine kidney therapy (KT) education, while those randomized to CKD-EDU received a decision aid and met with a PC clinician up to three times to discuss KT decisions and EoL planning.

Home Health Care and Place of Death in Medicare Beneficiaries With and Without Dementia.

Background And Objectives: Home health care supports patient goals for aging in place. Our objective was to determine if home health care use in the last 3 years of life reduces the risk of inpatient death without hospice.

Research Design And Methods: We analyzed the characteristics of 2,065,300 Medicare beneficiaries who died in 2019 and conducted multinomial logistic regression analyses to evaluate the association between the use and timing of home health care, dementia diagnosis, and place of death.

Palliative Care Acceptability for Older Adults with Advanced CKD: A Qualitative Study of Patients and Nephrologists.

Rationale & Objective: Older adults in the United States often receive kidney therapies that do not align with their goals. Palliative care (PC) specialists are experts in assisting patients with the goals of care discussions and decision support, yet views and experiences of older patients who have received PC while contemplating kidney therapy decisions and their nephrologists remain unexplored. We evaluated the acceptability of CKD-EDU, a PC-based kidney therapy decision support intervention for adults ≥75 years of age.

Comparing Nephrologists' Self-Reported Decision-Making Skills and Treatment Attitudes With Their Patients' Experiences of Making Kidney Therapy Decisions and Receiving Nephrology Care.

Background: Dialysis is often initiated in the United States without exploring patients' preferred decision-making style, and conservative kidney management (CKM) is infrequently presented. To improve kidney therapy (KT) decision-making, research on nephrologists' comfort with various decision-making styles, attitudes towards CKM, and reports of patients' lived experiences with KT decision-making is needed.

Methods: We surveyed 28 nephrologists and 58 of their patients aged ≥75 years.