LJ JAMES1,2, G WONG1,2,3, JC CRAIG1,2, A TONG1,2
1 Sydney School of Public Health, University of Sydney, Sydney, NSW 2006; 2Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW 2145; 3Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW 2145.
Aim: To describe nephrologists’ perspectives on cancer screening and understand the factors impacting their practice.
Background: Cancer is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). However, cancer screening practices are highly variable among nephrologists, which may reflect uncertainties around the benefits and harms of screening in this setting, and the competing risk of death from other causes.
Methods: Semi-structured interviews were conducted with 21 nephrologists from 11 centres across Australia and New Zealand. Transcripts were analysed thematically.
Results: Five themes were identified: empowering patients to make informed decisions (respecting patient preferences, communicating evidence-based recommendations, creating awareness of consequences, preparing patients for transplantation); justifiable risk taking (avoiding undue consequences in vulnerable populations, ensuring cost effectiveness, warranted by long term immunosuppression, assurance of reasonable survival gains); prioritising current or imminent complications; ambiguity of evidence in supporting decisions (absence of standardised recommendations, limited transferability of population-based data); and depending on a shared multidisciplinary approach (collaboration with primary health care, wary of inadequate dermatological services, generating targeted cancer preventative services).
Conclusion: Nephrologists approach decisions about cancer screening in patients with CKD based on patient preferences, assessment of risk, justifiable survival gains, and current health priorities. Evidence-based guidelines and specialist clinics that address cancer screening may support shared decision making about cancer screening in CKD.