Educational Support Around Dialysis Modality Decision Making in Patients With Chronic Kidney Disease: Qualitative Study

Cassidy, Brendan; Harwood, Lori; Getchell, Leah; Smith, Michael C.; Sibbald, Shannon L.; Moist, Louise

doi:10.1177/2054358118803323

Cited by 32 publications

(41 citation statements)

References 43 publications

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“…Recent studies have shown that the Surprise Question may be useful in helping clinicians identify poor prognoses and functional statuses as well as frailty among older patients with advanced CKD [38,44,45]. We also found that higher health literacy was associated with preference for supportive kidney care, which reinforces the importance of clear communication and dialogue between clinicians and patients to better assist them in navigating their health decisions [46]. Health literacy has been associated with advance care planningan important consideration for older patients with advanced CKD [47][48][49].…”

Section: Discussionsupporting

confidence: 68%

Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial

et al. 2020

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Background: There are few studies of patient-facing decision aids that include supportive kidney care as an option. We tested the efficacy of a video decision aid on knowledge of supportive kidney care among older patients with advanced CKD. Methods: Participants (age ≥ 65 years with advanced CKD) were randomized to receive verbal or video education. Primary outcome was knowledge of supportive kidney care (score range 0-3). Secondary outcomes included preference for supportive kidney care, and satisfaction and acceptability of the video. Results: Among all participants (n = 100), knowledge of supportive kidney care increased significantly after receiving education (p < 0.01); however, there was no difference between study arms (p = 0.68). There was no difference in preference for supportive kidney care between study arms (p = 0.49). In adjusted analyses, total health literacy score (aOR 1.08 [95% CI: 1.003-1.165]) and nephrologists' answer of "No" to the Surprise Question (aOR 4.87 [95% CI: 1.22-19.43]) were associated with preference for supportive kidney care. Most felt comfortable watching the video (96%), felt the content was helpful (96%), and would recommend the video to others (96%). Conclusions: Among older patients with advanced CKD, we did not detect Randomized Clinical Trial 737

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Section: Discussionsupporting

confidence: 68%

Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial

et al. 2020

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“…Thirdly, even though the surrogate outcome, the patients' knowledge and confidence in PD were increasing after video counseling, but it was not a significant difference between customized and conventional video counseling group. Deciding to have dialysis depends on many abstract aspects such other than knowledge and confidence in dialysis as personal values, beliefs, and feelings toward life, suffering, death and other patients experience (13)(14)(15)(16). In-depth interviews on this issue should be further evaluated.…”

Section: Discussionmentioning

confidence: 99%

Customized versus Conventional Video Counseling for Peritoneal Dialysis Decision-making in Chronic Kidney Disease Stage 5 under PD First Policy, A Randomized Controlled Study

Parapiboon¹,

Pitsawong²,

Thammavaranucupt³

et al. 2019

Preprint

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Purpose Un-decision for start peritoneal dialysis (PD) was a challenging problem with conventional video counseling in CKD stage 5. This study aims to evaluate customized (for local context) versus conventional video counseling for PD decision-making in CKD stage 5 under PD first policy. Methods In 120 CKD stage 5 in tertiary-care hospital, Thailand who indicated initiate PD between May 2016 to January 2017 were enrolled in a randomized, open-label, controlled study. Patients were randomized to customized and conventional video counseling. The primary outcome was the acceptance rate along with PD catheter insertion on schedule. The secondary outcomes included changing the patient’s knowledge and confidence in PD and unplanned start PD rate. Results 120 patients were analyzed (customized n=60; conventional n=60). The two groups were similar for age (55.7±12.3 vs. 56.2±13.4 years), BUN (89.8±30.8 vs. 86.8±29.5 mg/dL), Cr (10.37±5.39 vs. 11.29+4.90 mg/dl) and eGFR (4.78+2.79 vs. 5.62+2.82 mL/min/1.73m2). Acceptance rate along with PD catheter insertion on the schedule in customized video counselling group was not significant difference with conventional video counselling group (66.6% vs. 63.3%, relative risk 0.97, 95% confidence interval 0.73 to 1.29, p = 0.86). Patient’s knowledge and confidence in PD were increasing but not significant difference between both groups. Conclusions Among CKD stage 5 in PD first policy, customized counseling was not a significant difference in rate of accept for start PD along with PD catheter insertion on schedule with conventional video counseling. Other counseling method to improve the accept rate for start PD need to further investigation.

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“… 36 This begins with the appropriate incorporation of patients into the research process itself to realize their priorities, values, and experiences in recommendations for practice. 37 , 38 …”

Section: Reviewmentioning

confidence: 99%

“… 62 , 65 - 67 There is a large emotional toll associated with having CKD, especially when it comes to deciding on and initiating dialysis. 38 , 49 , 68 Anxiety, depression, and the emotional impact of dialysis are additional patient quality metrics that must be incorporated into CKD guidelines as they have been shown to predict patient morbidity, mortality, and QOL. 62 Psychologists are considered an essential part of any multidisciplinary RRT educational program.…”

Section: Reviewmentioning

confidence: 99%

Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review

Cassidy

Getchell²,

Harwood

et al. 2018

Can J Kidney Health Dis

Self Cite

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Purpose of review:Provision of education to inform decision making for renal replacement therapy (RRT) is a key component in the management of chronic kidney disease (CKD), yet patients report suboptimal satisfaction with the process of selecting a dialysis modality. Our purpose is to review the influencers of RRT decision making in the CKD population, which will better inform the process of shared decision making between clinicians and patients.Sources of information:PubMed and Google Scholar.Methods:A narrative review was performed using the main terms “chronic kidney disease,” “CKD,” “dialysis,” “review,” “decision-making,” “decision aids,” “education,” and “barriers.” Only articles in English were accessed. The existing literature was critically analyzed from a theoretical and contextual perspective and thematic analysis was performed.Key findings:Eight common themes were identified as influencers for decision making. “Patient-focused” themes including social influence, values and beliefs, comprehension, autonomy and sociodemographics, and “clinician-focused” themes including screening, communication, and engagement. Early predialysis education and decision aids can effectively improve decision making. Patient-valued outcomes need to be more fully integrated into clinical guidelines.Limitations:This is not a systematic review; therefore, no formal tool was utilized to evaluate the rigor and quality of studies included and findings may not be generalizable.Implications:Standardized comprehensive RRT education programs through multidisciplinary health teams can help optimize CKD patient education and shared decision making. Involving patients in the research process itself and implementing patient values and preferences into clinical guidelines can help to achieve a patient-centered model of care.

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Educational Support Around Dialysis Modality Decision Making in Patients With Chronic Kidney Disease: Qualitative Study

Cited by 32 publications

References 43 publications

Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial

Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial

Customized versus Conventional Video Counseling for Peritoneal Dialysis Decision-making in Chronic Kidney Disease Stage 5 under PD First Policy, A Randomized Controlled Study

Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review

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