Identifying Outcomes Important to Patients with Glomerular Disease and Their Caregivers

  • Simon A. Carter
    Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  • Talia Gutman
    Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  • Charlotte Logeman
    Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  • Dan Cattran
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • Liz Lightstone
    Centre for Inflammatory Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
  • Arvind Bagga
    Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
  • Sean J. Barbour
    Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • Jonathan Barratt
    Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
  • John Boletis
    Nephrology Department and Renal Transplantation Unit, Medical School, University of Athens, Laiko Hospital, Athens, Greece
  • Dawn Caster
    Division of Nephrology, University of Louisville, Kentucky, Louisville
  • Rosanna Coppo
    Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
  • Fernando C. Fervenza
    Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
  • Jürgen Floege
    Department of Nephrology and Clinical Immunology, Rheinisch-Westfälische Technische Hochschule University Hospital, Aachen, Germany
  • Michelle Hladunewich
    Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  • Jonathan J. Hogan
    Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
  • A. Richard Kitching
    Department of Nephrology, Monash Health, Clayton, Victoria, Australia
  • Richard A. Lafayette
    Stanford University Medical Center, Stanford, California
  • Ana Malvar
    Nephrology, Hospital Fernández, Buenos Aires, Argentina
  • Jai Radhakrishnan
    Colombia University Medical Center, New York, New York
  • Brad H. Rovin
    Division of Nephrology, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
  • Nicole Scholes-Robertson
    Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  • Hérnan Trimarchi
    Nephrology Service and Kidney Transplantation Unit, Hospital Britanico de Buenos Aires, Buenos Aires, Argentina
  • Hong Zhang
    Renal Division, Peking University First Hospital, Beijing, China
  • Karolis Azukaitis
    Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
  • Yeoungjee Cho
    Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Andrea K. Viecelli
    Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Louese Dunn
    Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
  • David Harris
    Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
  • David W. Johnson
    Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Peter G. Kerr
    Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
  • Paul Laboi
    Department of Nephrology, York Hospital, York, United Kingdom
  • Jessica Ryan
    Department of Nephrology, Monash Health, Clayton, Victoria, Australia
  • Jenny I. Shen
    Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
  • Lorena Ruiz
    Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California
  • Angela Yee-Moon Wang
    Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
  • Achilles Hoi Kan Lee
    Department of Medicine, Tuen Mun Hospital, Hong Kong, China
  • Samuel Fung
    Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
  • Matthew Ka-Hang Tong
    Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong, China
  • Armando Teixeira-Pinto
    Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  • Martin Wilkie
    Department of Nephrology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
  • Stephen I. Alexander
    Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  • Jonathan C. Craig
    College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
  • Allison Tong
    Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia

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<jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>Shared decision making in patients with glomerular disease remains challenging because outcomes important to patients remain largely unknown. We aimed to identify and prioritize outcomes important to patients and caregivers and to describe reasons for their choices.</jats:p> </jats:sec> <jats:sec> <jats:title>Design, setting, participants, & measurements</jats:title> <jats:p>We purposively sampled adult patients with glomerular disease and their caregivers from Australia, Hong Kong, the United Kingdom, and the United States. Participants identified, discussed, and ranked outcomes in focus groups using the nominal group technique; a relative importance score (between zero and one) was calculated. Qualitative data were analyzed thematically.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Across 16 focus groups, 134 participants (range, 19–85 years old; 51% women), including 101 patients and 33 caregivers, identified 58 outcomes. The ten highest-ranked outcomes were kidney function (importance score of 0.42), mortality (0.29), need for dialysis or transplant (0.22), life participation (0.18), fatigue (0.17), anxiety (0.13), family impact (0.12), infection and immunity (0.12), ability to work (0.11), and BP (0.11). Three themes explained the reasons for these rankings: constraining day-to-day experience, impaired agency and control over health, and threats to future health and family.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Patients with glomerular disease and their caregivers highly prioritize kidney health and survival, but they also prioritize life participation, fatigue, anxiety, and family impact.</jats:p> </jats:sec>

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