About OSCAR

‌‌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.

The OSCAR study investigated 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 four hospital sites we:

  1. Observed renal clinicians' appointments with patients and carers who chose to take part, interviewed renal clinicians, and evaluated the information and decision making resources given to patients.

  2. Video-recorded 60-80 consultations between c.20 renal clinicians and patients (and carers) who chose to take part, surveyed patients and carers and renal clinicians on their consultation and decision making process, and interviewed patients and carers on their experience of communication and decision making.

Using findings from these Work Packages, we then designed training for renal clinicians, working closely with a Stakeholder Panel (patients, carers, clinicians, educators and commissioners) and integrating the findings,  evidence and theory from the first two Work Packages, and refined the training through ‘think aloud’ interviews with renal clinicians. 

Finally, we piloted the training with renal clinicians, using pre and post training surveys and qualitative interviews to find out renal clinicians' views/experiences, further refine the training, and prepare for a full evaluation.

Dissemination

We will be sharing our findings in open-access journal publications, linked blogs, conference presentations, policy/media briefings, freely-available plain English summaries, and a short video. See Publications and presentations for updates. Follow us on Twitter @OSCAR_study.