Rationale & Objective:

Greater prognostic understanding is associated with higher quality care at the end of life. We undertook a scoping review to explore how long dialysis recipients expect to live.
Study Design:

Scoping Review
Setting and Study Population:

People with kidney failure over 18 years old.
Search Strategy & Sources:

Studies were identified by searching Medline, Embase, APA PsycINFO, HMIC and ProQuest Database for terms related to “life expectancy”, “self -estimated” and “end stage kidney disease”.
Data Extraction:

Search strategies yielded 349 unique, potentially eligible studies, with 8 meeting the inclusion criteria after screening.

Results:

Significant mismatches between dialysis recipients and their healthcare provider estimations of prognosis were reported, with patients predicting significantly higher life expectancies than healthcare professionals and almost no agreement between patient and nephrologist estimates of one-year survival. Documented cognitive impairment did not affect 1- or 5-year prognosis estimates, neither did gender, age, time on dialysis or discussing perceived life expectancy. Dialysis recipients who thought they were on the transplant-list or self-identified as black had higher perceived life expectancy: people who were 75 years or older, or with fair/ poor self-reported health status had lower. Those with lower perceived life expectancy preferred care focusing on relieving pain and discomfort: people who thought they had a higher chance of survival were significantly more likely to prefer life-extending care.
Limitations:

There is a marked paucity of research in this area with most studies conducted in North American cohorts.
Conclusions:

Optimistic patient prognostic expectations persist in dialysis recipients. Given the effects of perceived life expectancy on treatment choices and subsequent quality of life, it is important that transparent discussions regarding prognosis are conducted with people receiving dialysis and their families.