‌‌Every year in the UK, 3,500 adults over 65 with end-stage kidney disease start dialysis. They are the fastest growing group of recipients. However, for older people, the survival benefits of dialysis are uncertain and it greatly impacts upon quality of life. Comprehensive conservative care is a beneficial alternative to dialysis for older patients, particularly for people who have other difficulties, disabilities or frailty.

There is evidence of huge unwarranted variation in rates of conservative care: from 5% to 95% among patients aged 75 or older across UK renal units (Roderick et al. 2014). One reason for this is differences in how clinicians communicate about treatment options, which strongly influences patients’ decision-making.

We will investigate how renal clinicians communicate with older people with advanced kidney disease when they're deciding what treatment to have. 

Design

OSCAR is split into four Work Packages of research. In the first two Work Packages, across five hospital sites we will:

1. Observe renal clinicians' appointments with patients and carers who choose to take part, interview renal clinicians, and evaluate information and decision making resources given to patients.

2. Video-record 60-80 consultations between 20 renal clinicians and patients (and carers) who choose to take part, survey patients and carers and renal clinicians on their consultation and decision making process, and interview patients (and carers) on their experience of communication and decision making.

For the last two Work Packages, at one hospital site we will:

3. Design training for renal clinicians. This will be co-produced with Stakeholder Panel (patients, carers, clinicians, educators and commissioners) and integrate the findings,  evidence and theory from the first two stages of research, and refined through ‘think aloud’ interviews with renal clinicians

4. Pilot the training in a sixth renal unit, using pre and post training surveys to find out renal clinicians' views/experiences, video-record post-training consultations to determine whether and how it is put into practice, and finally further refine the training to prepare for full evaluation.

Dissemination

We will share our findings in open-access journal publications, linked blogs, conference presentations, policy/media briefings, freely-available plain English summaries, and a short video. Follow us on Twitter @OSCAR_study to keep up to date.