Dr Barny Hole
DipMedEd, MBChB, BSc (Hons), PhD
Expertise
Current positions
NIHR Academic Clinical Lecturer in Health Needs of Older People: Renal Medicine
Bristol Medical School (PHS)Honorary Research Associate
Bristol Medical School (PHS)
Contact
Press and media
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Research interests
I am a kidney doctor and researcher. My research looks at how health systems can get the right balance between preventative treatment, management of disease, and care focussed on people’s quality of life.
My PhD looked at how older people with kidney failure decide between dialysis (a kidney machine) and conservative kidney management (treatment of symptoms, social and psychological problems without dialysis). I showed that they would accept shorter lives if this protected their independence and decreased treatment burdens such as hospital visits, intrusion into the home, and time lost to treatment. Subgroups showed marked differences in their acceptance of hospital time vs. treatment at home, and readiness to relinquish survival to maintain independence. Family members were crucially important in decision-making, but appeared less willing to renounce potential life prolongation than patients were for themselves. Whilst characteristics such as age did not appear to influence individuals’ preferences, partnered patients valued life-prolongation more than the unpartnered.
My study highlights the need for health services that offer greater individualisation and choice, prioritise independence, and minimise intrusion from treatment. It leaves important questions: i) were the trade-offs elicited unique to participants considering kidney failure, or did I inadvertently capture higher-level preferences amongst older people living with multiple long-term conditions? and ii) were participants’ preferences fixed, or will they change over time?
I am developing follow-on research with a more inclusive group of older people to answer the following question: What outcomes do older people with multiple long-term conditions prioritise when considering medical treatments, and how do the trade-offs made between perceived benefits and burdens change as they age and experience life events?
Projects and supervisions
Research projects
NIHR Academic Clinical Lectureship - Healthcare needs of older people (Kidney disease)
Principal Investigator
Managing organisational unit
Bristol Medical School (PHS)Dates
01/02/2023 to 02/11/2026
The burden of polypharmacy in older people with advanced chronic kidney disease
Role
Co-Investigator
Description
Exploring the prevalence of polypharmacy and the changes in prescribing prior to death in older people with advanced chronic kidney disease.Managing organisational unit
Bristol Medical SchoolDates
01/08/2017 to 22/09/2023
Publications
Recent publications
03/05/2024A Multinational, Multicenter Study Mapping Models of Kidney Supportive Care Practice
Kidney international reports
An introduction to realist evaluation and synthesis for kidney research
Kidney International
Development of a Resource for Health Professionals to Raise Advance Care Planning Topics During Kidney Care Consultations: A Multiple User-Centered Design
Kidney Medicine
Global access and quality of conservative kidney management
Nephrology Dialysis Transplantation
Older Patients’ Preferences for Kidney Failure Treatments: A Choice Experiment
Kidney International
Thesis
Understanding the treatment preferences of older patients deciding between dialysis and conservative kidney management
Supervisors
Award date
24/01/2023