Patient and Provider health outcome priorities
An increasing percentage of older Americans suffer from chronic kidney disease (CKD). Often, treatment regimens for CKD and associated comorbidities must prioritize particular health outcomes over alternative important outcomes (e.g., length of survival vs. pain control). This presents patients with difficult decisions regarding trade-offs and health outcome priorities. In assessing these tradeoffs, providers usually select the outcome which they consider important but unfortunately these perceptions are often discordant with patient priorities. This can lead to a lack of understanding, underuse of end of life care resources, overly aggressive care with limited patient perceived benefit, and patient dissatisfaction. These knowledge gaps contribute to missed opportunities to identify patients and caregivers who could benefit from timely interventions to alleviate mental and physical symptom burdens and/or engage in end of life planning. Addressing this knowledge gap may assist in the development of decision aids that facilitate congruence between patient values and treatment as well as reduce decisional conflict.