Doctoral Defense in Public Health Sciences – Björg Þorsteinsdóttir

On Tuesday, January 27, Björg Þorsteinsdóttir will defend her doctoral dissertation in Public Health Sciences at the Faculty of Medicine, University of Iceland.
The title of the dissertation is:

Development of the CKD Journeys Decision Aid to Promote Shared Decision Making in Patients with Advanced Kidney Disease.

The opponents are Dr. Willem Jan Bos, Professor at Leiden University Medical Center, and Dr. Andrew C. Nixon, nephrologist and Lead for Supportive and Palliative Care at Lancashire Teaching Hospitals NHS Foundation Trust.

The principal supervisor was Runólfur Pálsson, Professor of Internal Medicine (Nephrology).
The supervisor was Dr. Jon C. Tilburt, Professor at Mayo Clinic Arizona, and the co-supervisor was María Heimisdóttir, Director of Health.
In addition, the doctoral committee included Dr. Ann M. O’Hare, Professor at the University of Washington, Seattle, and Dr. Mildred Z. Solomon, Professor at Harvard Medical School, Boston.

Sædís Sævarsdóttir, Professor and Dean of the Faculty of Medicine, will chair the ceremony, which will take place in the Ceremonial Hall (Hátíðasalur) of the University of Iceland and begin at 13:00.

Abstract

The prevalence of end stage kidney disease (ESKD) and the use of hemodialysis have been increasing beyond population growth, contributing to unsustainable healthcare spending. ESKD carries a symptom burden and mortality risk comparable to advanced cancer. For certain high-risk groups, there is equipoise regarding whether dialysis extends or improves life compared with supportive care without dialysis. Nonetheless, many physicians perceive dialysis initiation as imperative, and patients often feel they have no real choice but to start dialysis.

The overall goal of this doctoral research was to promote awareness of choice and shared decision making regarding treatment options in older adults with ESKD, for both patients and clinicians, through the development of CKD Journeys, an interactive decision aid designed for use in clinical encounters. A patient and user centered approach was applied.

Systematic reviews of prognostic indices revealed a lack of reliable mortality indices and comprehensive, validated decision aids. A propensity-matched comparative survival analysis showed that initiation of dialysis was associated with a consistent, though modest, survival benefit compared with no dialysis, even among the oldest patients. Qualitative analyses highlighted variability in patients’ preferences for prognostic information. More patients were interested in understanding whether they might reach ESKD than in knowing how long they might live. Patients preferred prognostic information to be shared early in the disease course, and most were accepting of uncertainty.

CKD Journeys presents individualized estimates of ESKD risk, the competing risk of death, and comparative survival across different treatment options, as well as other outcomes known to be important to patients with ESKD.

About the Doctoral Candidate

Björg Þorsteinsdóttir was born in 1972 in Reykjavík. She completed her secondary education in physics at Menntaskólinn í Reykjavík and earned her medical degree in 1999. Alongside her studies, she served as President of the International Federation of Medical Students’ Associations (IFMSA) during the 1997–1998 academic year.

After completing her internship, Björg worked as a junior physician in various departments at Landspítali before pursuing postgraduate training abroad. She completed her residency in General Internal Medicine at the Mayo Clinic in Minnesota in 2005 and later earned a postgraduate qualification in Bioethics from Harvard Medical School in 2008. From 2008 to 2011, she worked in the Department of Health Economics and Information and the Palliative Care Unit at Landspítali. She became board-certified in Palliative Medicine in 2012.

Since 2011, Björg has worked as a general internist and palliative care physician at the Mayo Clinic, where she is also involved in teaching and research. Her doctoral project was funded by Satellite Healthcare, the National Institute on Aging, and the Mayo Clinic.

Björg’s parents are Þorsteinn Tómasson, plant geneticist, and Sophie Kofoed Hansen, special education teacher. Her husband is Bo Enemark Madsen, emergency physician, and they have four children: Jóhannes, Harald, Sophie, and Kirsten.