Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care

Abstract

Rationale & Objective Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients’ preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. Study Design Cross-sectional study. Setting & Participants Adults receiving nephrology care at CKD clinics in rural Pennsylvania. Predictors Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. Outcomes Occurrence and extent of kidney replacement therapy discussions and participants’ satisfaction with those discussions. Analytic Approach Multivariable logistic regression to quantify associations between participants’ characteristics and whether they had discussions. Results The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m 2 . Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. Limitations Single health system study. Conclusions Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences.

Dialysis Organization Online Information on Kidney Failure Treatments: A Content Analysis Using Corpus Linguistics

“… 20 Thus, calls for studies on how patients make decisions from a variety of inputs have been made. 15 , 21 , 22 Such calls are consistent with the literature across disciplines—in linguistics, 23 medicine, 21 and communications 24 —which suggests that patients and people in general create and shape understandings and misunderstandings of their worlds based on what is read, heard, and seen in a variety of circumstances across time.…”

“…Clinicians have the ethical responsibility of discussing dialysis outcomes with patients, 14 and provider discussions are patients’ preferred sources of information. 15 Yet goal-concordant and informed decision making seldom occur for patients choosing kidney replacement therapies 16 because, in part, nephrologists infrequently receive communication and decision-making skill training. 17 , 18 Furthermore, communicating that, in certain cases, dialysis may not extend life expectancy is not easy, conceptually or emotionally, for patient or provider.…”

Patients’ and healthcare professionals’ perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: A scoping review

“…Six studies were concerned with SDM consultations as their object of study. [53][54][55][56][57][58] Two of these conducted the study before the consultation, three studies were conducted after the consultation and one article refers to conducting the study before and after the SDM consultation. One article explores surgeons' perspectives on SDM.…”

Langfristige körperliche und psychische Folgen chronischer Nierenerkrankungen

“…Die Patient:innen sollten in ihrem Selbstmanagement unterstützt und in alle therapeutischen Entscheidungen eingebunden werden (Shared Decision Making; [ 50 – 54 ]). Sie müssen die Tragweite der Entscheidungen verstehen und diese mitverantworten können.…”