Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis

Karla Gonzalez, Jesus G. Ulloa, Gerardo Moreno, Oscar Echeverría, Keith Norris, Efrain Talamantes

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults. Methods: Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations. Results: The majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69% of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38% in the non-ESRD group. Primary themes centered on 1) The acceptability of a "natural" versus "invasive" procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making. Conclusion: Our results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.

Original languageEnglish (US)
Article number319
JournalBMC Nephrology
Volume18
Issue number1
DOIs
StatePublished - Oct 23 2017

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Hispanic Americans
Chronic Kidney Failure
Dialysis
Focus Groups
Morbidity
Hospital Emergency Service
Independent Living
Kidney
Insurance Coverage
Vulnerable Populations
Health Insurance
Renal Dialysis
Decision Making
Language
Demography
Interviews
Physicians
Mortality

Keywords

  • Advanced care planning
  • Dialysis
  • End of life
  • Intensive procedures
  • Latinos
  • Renal disease

ASJC Scopus subject areas

  • Nephrology

Cite this

Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis. / Gonzalez, Karla; Ulloa, Jesus G.; Moreno, Gerardo; Echeverría, Oscar; Norris, Keith; Talamantes, Efrain.

In: BMC Nephrology, Vol. 18, No. 1, 319, 23.10.2017.

Research output: Contribution to journalArticle

Gonzalez, Karla ; Ulloa, Jesus G. ; Moreno, Gerardo ; Echeverría, Oscar ; Norris, Keith ; Talamantes, Efrain. / Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis. In: BMC Nephrology. 2017 ; Vol. 18, No. 1.
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abstract = "Background: Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults. Methods: Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study. Those without ESRD (n = 47) participated in one of five focus group sessions, and those with ESRD on dialysis (n = 26) participated in one-on-one semi-structured interviews. Focus group and individual participants answered questions regarding intensive procedures at the EOL. Recurring themes were identified using standard qualitative content-analysis methods. Participants also completed a brief survey that included demographics, language preference, health insurance coverage, co-morbidities, Emergency Department visits and functional limitations. Results: The majority of participants were of Mexican origin with mean age of 70, and there were more female participants in the non-ESRD group, compared to the ESRD dialysis dependent group. The dialysis group reported a higher number of co-morbidities and functional limitations. Nearly 69{\%} of those in the dialysis group reported one or more emergency department visits in the past year, compared to 38{\%} in the non-ESRD group. Primary themes centered on 1) The acceptability of a {"}natural{"} versus {"}invasive{"} procedure 2) Cultural traditions and family involvement 3) Level of trust in physicians and autonomy in decision-making. Conclusion: Our results highlight the need for improved patient- and family-centered approaches to better understand intensive procedure preferences at the EOL in this underserved population of older adults.",
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AU - Norris, Keith

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