Premium
Nephrologists' perspectives on cancer screening in patients with chronic kidney disease: An interview study
Author(s) -
James Laura,
Wong Germaine,
Craig Jonathan C.,
Howard Kirsten,
Howell Martin,
Tong Allison
Publication year - 2019
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.13269
Subject(s) - medicine , population , kidney disease , family medicine , disease , intensive care medicine , nursing , environmental health
Aim Patients with chronic kidney disease (CKD) have an increased risk of cancer compared with the general population. Despite this, there is considerable variability in cancer screening practices among nephrologists that may reflect uncertainties about the benefits and harms of screening, the additional costs, and competing priorities among the complex issues that patients are confronted with. We aimed to describe nephrologists' perspectives and approaches to cancer screening in CKD. Methods Semi‐structured interviews were conducted with 29 nephrologists from 15 units across Australia and New Zealand. Interviews were transcribed and thematically analyzed. Results Five themes were identified: empowering patients to make informed decisions (respecting patient preferences, communicating evidence‐based recommendations, creating awareness of consequences, preparing for transplantation); justifiable risk taking (avoiding undue consequences in vulnerable populations, balancing the costs and benefits, warranted by long term immunosuppression, assurance of reasonable survival gains); ambiguity of evidence in supporting decisions (absence of standardized recommendations, limited transferability of population‐based data); depending on a shared multidisciplinary approach (collaboration with primary health care, access to coordinated skin cancer clinics); and prioritizing current or imminent complications. Conclusion Nephrologists approach decisions about cancer screening in patients with CKD based on patient preferences, assessment of risk, justifiable survival gains, and current health priorities. Evidence‐based guidelines, communication frameworks and specialist clinics may support informed and shared decision making about cancer screening in CKD.