Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study
Rationale & Objective: Although kidney biopsy is a useful tool, nephrologists’ approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to pe...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-11-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S259005952100203X |
| _version_ | 1818721304125112320 |
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| author | Afolarin Amodu Thalia Porteny Insa M. Schmidt Keren Ladin Sushrut S. Waikar |
| author_facet | Afolarin Amodu Thalia Porteny Insa M. Schmidt Keren Ladin Sushrut S. Waikar |
| author_sort | Afolarin Amodu |
| collection | DOAJ |
| description | Rationale & Objective: Although kidney biopsy is a useful tool, nephrologists’ approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to perform native kidney biopsy. Study Design: Qualitative study using semistructured interviews. Setting & Participants: Purposive sampling was used to select nephrologists from different regions in the United States. Semistructured interviews were continued until thematic saturation. Analytical Approach: A modified grounded theory was used to identify dominant themes reflecting the nephrologists’ decision-making styles about kidney biopsy. Results: Twenty nephrologists were interviewed: 16 (80%) were from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than 10 years. The median time of practice was 14 years. We found substantial variability among the nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighing the risks and benefits of the procedure for an individual patient. Five overarching themes were identified: operator comfort with biopsy and availability of interventional radiologist, exposure to biopsy during training and years of experience, concerns about the invasiveness of biopsy and inflicting harm, perception of evidence base and limited treatment options, and patient characteristics and preference. Limitations: Generalizability was limited because the nephrologists sampled may not have been broadly representative. Conclusions: Multiple factors influence nephrologists’ decision to pursue kidney biopsy, with substantial variability among nephrologists that can have meaningful clinical implications. This suggests the need to establish consensus guidelines to make biopsy practice more standardized. |
| first_indexed | 2024-12-17T20:36:36Z |
| format | Article |
| id | doaj.art-1e3e450276ef4df6b5209853caf57d15 |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-12-17T20:36:36Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-1e3e450276ef4df6b5209853caf57d152022-12-21T21:33:25ZengElsevierKidney Medicine2590-05952021-11-013610221031Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative StudyAfolarin Amodu0Thalia Porteny1Insa M. Schmidt2Keren Ladin3Sushrut S. Waikar4Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston; Division of Renal Medicine, Brigham and Women’s Hospital, Boston; Address for Correspondence: Afolarin Amodu, MD, MPH, Boston University Medical Center, Evans Biomedical Research Center, 5th Floor, 650 Albany Street, Boston, MA 02118.Department of Occupational Therapy, Tufts University, Medford, Massachusetts; Research on Aging, Ethics, and Community Health (REACH Lab), Tufts University, Medford, MassachusettsSection of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston; Division of Renal Medicine, Brigham and Women’s Hospital, BostonDepartment of Occupational Therapy, Tufts University, Medford, Massachusetts; Research on Aging, Ethics, and Community Health (REACH Lab), Tufts University, Medford, MassachusettsSection of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston; Division of Renal Medicine, Brigham and Women’s Hospital, BostonRationale & Objective: Although kidney biopsy is a useful tool, nephrologists’ approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to perform native kidney biopsy. Study Design: Qualitative study using semistructured interviews. Setting & Participants: Purposive sampling was used to select nephrologists from different regions in the United States. Semistructured interviews were continued until thematic saturation. Analytical Approach: A modified grounded theory was used to identify dominant themes reflecting the nephrologists’ decision-making styles about kidney biopsy. Results: Twenty nephrologists were interviewed: 16 (80%) were from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than 10 years. The median time of practice was 14 years. We found substantial variability among the nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighing the risks and benefits of the procedure for an individual patient. Five overarching themes were identified: operator comfort with biopsy and availability of interventional radiologist, exposure to biopsy during training and years of experience, concerns about the invasiveness of biopsy and inflicting harm, perception of evidence base and limited treatment options, and patient characteristics and preference. Limitations: Generalizability was limited because the nephrologists sampled may not have been broadly representative. Conclusions: Multiple factors influence nephrologists’ decision to pursue kidney biopsy, with substantial variability among nephrologists that can have meaningful clinical implications. This suggests the need to establish consensus guidelines to make biopsy practice more standardized.http://www.sciencedirect.com/science/article/pii/S259005952100203XBiopsy guidelineclinical biopsyindications for kidney biopsykidney biopsyphysician attitudequalitative research |
| spellingShingle | Afolarin Amodu Thalia Porteny Insa M. Schmidt Keren Ladin Sushrut S. Waikar Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study Kidney Medicine Biopsy guideline clinical biopsy indications for kidney biopsy kidney biopsy physician attitude qualitative research |
| title | Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study |
| title_full | Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study |
| title_fullStr | Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study |
| title_full_unstemmed | Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study |
| title_short | Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study |
| title_sort | nephrologists attitudes toward native kidney biopsy a qualitative study |
| topic | Biopsy guideline clinical biopsy indications for kidney biopsy kidney biopsy physician attitude qualitative research |
| url | http://www.sciencedirect.com/science/article/pii/S259005952100203X |
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