Understanding factors that influence the demand for dialysis among elderly in a multi-ethnic Asian society.

Journal Article (Journal Article)

Background

Despite literature suggesting conservative management (CM) is a viable option for elderly comorbid ESRD patients, the vast majority in Singapore receive dialysis. We hypothesized that the high demand for dialysis is driven by 1) lack of knowledge of CM and relative benefits of dialysis to CM, 2) adherence to physician recommendations which favour dialysis, and 3) high subsidies for haemodialysis (HD).

Methods

We tested these hypotheses via a survey, including a discrete choice experiment (DCE), administered to 151 elderly pre-dialysis kidney patients and their family caregivers.

Results

Results are consistent with the hypotheses: 40% (95% Confidence Interval (CI) 32-48) of patients and 46% (CI 38-55) of caregivers reported not being aware of CM, and 43% (CI 35-51) of patients and 24% (CI 17-31) of caregivers could not provide information on expected survival for dialysis or CM. Yet, once aware of CM as an option, 54% of patients and 42% of caregivers chose CM. However, if their physician recommended dialysis, 49% (CI 40-58) of patients and 68% (CI 59-77) of caregivers switched their choice. Subsidies on HD further reduced demand for CM by 6 percentage points.

Conclusions

These results reveal that the high demand for dialysis is driven mostly by lack of awareness of CM as an option and by physician recommendations for dialysis over CM.

Full Text

Duke Authors

Cited Authors

  • Finkelstein, EA; Ozdemir, S; Malhotra, C; Jafar, TH; Choong Hui Lin, L; Gan Shien Wen, S

Published Date

  • August 2018

Published In

Volume / Issue

  • 122 / 8

Start / End Page

  • 915 - 921

PubMed ID

  • 30007521

Electronic International Standard Serial Number (EISSN)

  • 1872-6054

International Standard Serial Number (ISSN)

  • 0168-8510

Digital Object Identifier (DOI)

  • 10.1016/j.healthpol.2018.06.008

Language

  • eng