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Patient Ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis
Haya R. Rubin, MD, PhD;
Nancy E. Fink, MPH;
Laura C. Plantinga, ScM;
John H. Sadler, MD;
Alan S. Kliger, MD;
Neil R. Powe, MD, MPH, MBA
JAMA. 2004;291:697-703.
Context In light of conflicting evidence of differential effects of dialysis modality on survival, patient experience becomes a more important consideration in choosing between hemodialysis and peritoneal dialysis.
Objective To compare patient satisfaction with hemodialysis and peritoneal dialysis in a cohort of patients who have recently begun dialysis.
Design and Setting Cross-sectional survey at enrollment in a prospective inception cohort study of patients who recently started dialysis at 37 dialysis centers participating in the Choices for Healthy Outcomes in Caring for End-stage Renal Disease (CHOICE) study, a national multicenter study of dialysis outcomes, from October 1995 to June 1998.
Patients Of 736 enrolled incident dialysis patients, 656 (89%) returned a satisfaction questionnaire after an average of 7 weeks of dialysis.
Main Outcome Measure Data collected from a patient-administered questionnaire including 3 overall ratings and 20 items rating specific aspects of dialysis care.
Results Patients receiving peritoneal dialysis were much more likely than those receiving hemodialysis to give excellent ratings of dialysis care overall (85% vs 56%, respectively; relative probability, 1.46 [95% confidence interval, 1.31-1.57]) and significantly more likely to give excellent ratings for each specific aspect of care rated. The 3 items with the greatest differences were in the domain of information provided (average of information items: peritoneal dialysis [69% excellent] vs hemodialysis [30% excellent]). The smallest differences were in ratings of accuracy of information from the nephrologist, response to pain, amount of fluid removed, and staff availability in an emergency. Adjustment for patient age, race, education, health status, marital status, employment status, distance from the center, and time since starting dialysis did not reduce the differences between peritoneal dialysis and hemodialysis patients.
Conclusions After several weeks of initiating dialysis, patients receiving peritoneal dialysis rated their care higher than those receiving hemodialysis. These findings indicate that clinicians should give patients more information about the option of peritoneal dialysis.
Author Affiliations: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Md (Drs Rubin and Powe and Mss Fink and Plantinga); Department of Health Policy and Management (Drs Rubin and Powe) and Department of Epidemiology (Drs Rubin and Powe and Ms Fink), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Independent Dialysis Foundation, Baltimore, Md (Dr Sadler); and Department of Medicine, Hospital of St Raphael and Department of Medicine, Yale University, New Haven, Conn (Dr Kliger).
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