Patient and Caregiver Perspectives on Terms Used to Describe Kidney Health

Clin J Am Soc Nephrol. 2020 Jul 1;15(7):937-948. doi: 10.2215/CJN.00900120. Epub 2020 Jun 25.

Abstract

Background and objectives: The language used to communicate important aspects of kidney health is inconsistent and may be conceptualized differently by patients and health professionals. These problems may impair the quality of communication, care, and patient outcomes. We aimed to describe the perspectives of patients on terms used to describe kidney health.

Design, setting, participants, & measurements: Patients with CKD (n=54) and caregivers (n=13) from the United States, United Kingdom, and Australia participated in ten focus groups to discuss terms for kidney health (including kidney, renal, CKD, ESKD, kidney failure, and descriptors for kidney function). We analyzed the data using thematic analysis.

Results: We identified four themes: provoking and exacerbating undue trauma (fear of the unknown, denoting impending death, despair in having incurable or untreatable disease, premature labeling and assumptions, judgment, stigma, and failure of self); frustrated by ambiguity (confused by medicalized language, lacking personal relevance, baffled by imprecision in meaning, and/or opposed to obsolete terms); making sense of the prognostic enigma (conceptualizing level of kidney function, correlating with symptoms and effect on life, predicting progression, and need for intervention); and mobilizing self-management (confronting reality, enabling planning and preparation, taking ownership for change, learning medical terms for self-advocacy, and educating others).

Conclusions: The obscurity and imprecision of terms in CKD can be unduly distressing and traumatizing for patients, which can impair decision making and self-management. Consistent and meaningful patient-centered terminology may improve patient autonomy, satisfaction, and outcomes.

Keywords: Australia; caregivers; chronic; chronic kidney disease; communication; decision making; education; fear; focus groups; judgment; kidney failure; language; nomenclature; ownership; patient participation; patient-centered care; personal satisfaction; prognosis; renal insufficiency; self-management.