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" 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
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AL
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| Record Number
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920692
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LA9zt680r5
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Intensive procedure preferences at the end of life (EOL) in older Latino adults with end stage renal disease (ESRD) on dialysis. [Article]\ Gonzalez, Karla; Ulloa, Jesus G; Moreno, Gerardo; Echeverría, Oscar; Norris, Keith
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2017
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UC Davis
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| Abstract
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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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