Shared Decision Making Among Older Adults With Advanced CKD

Frazier, Rebecca; Levine, Sarah; Porteny, Thalia; Tighiouart, Hocine; Wong, John B.; Isakova, Tamara; Koch‐Weser, Susan; Gordon, Elisa J.; Weiner, Daniel E.; Ladin, Keren

doi:10.1053/j.ajkd.2022.02.017

Cited by 16 publications

(15 citation statements)

References 61 publications

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“…Encouragingly, recent work shows that decision aids show promise in increasing knowledge in older patients with CKD, and this research should be built on in future systems improvement initiatives for kidney care. 27 …”

Section: Discussionmentioning

confidence: 99%

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study

Annadanam¹,

Garg²,

Fagerlin³

et al. 2023

Kidney Medicine

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Section: Discussionmentioning

confidence: 99%

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study

Annadanam¹,

Garg²,

Fagerlin³

et al. 2023

Kidney Medicine

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“…This is promising, as previous studies have shown that effective communication between doctors and patients, as well as clear information sharing, can improve the level of SDM. 14 , 24 To build on this, it may be necessary for medical staff to actively explore patients’ individual needs for medical information and focus on the effectiveness of information delivery to enhance the patient experience of SDM participation. In contrast, the second, sixth, and eighth items had low scores, which related to the level of patient involvement and the preferences involved in decision-making.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the findings of Fu et al and Hahlweg et al 25 , 26 Clarifying patients’ decision-making preferences can help medical staff support patients in the way they want. 14 A one-way information exchange can occur when there is an imbalance between the content of the information provided by doctors and the information obtained from patients. However, consensus also can be reached in decision-making when patients have more confidence in the knowledge, experience, and advice given by their doctors.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Participation in Shared Decision-Making Among Patients with Glaucoma in China: A Cross-Sectional Study

Sun,

Zhou,

Zuo

et al. 2023

PPA

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Purpose To explore the level of participation in shared decision-making by patients with glaucoma and identify influencing factors, to subsequently provide references to promote shared decision-making in ophthalmology, and achieve patient-centered care. Patients and Methods A questionnaire was completed by 148 patients with glaucoma who had been admitted to a specialized ophthalmic hospital in China, between October 2021 and January 2022. The participants’ responses to the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) and a general information survey were analyzed to determine their level of participation in shared decision-making and influencing factors. Multiple linear regression was used to identify factors that influence shared decision-making at the time of clinical practice. Results The mean score of SDM-Q-9 was 71.73±21.27 (n=140). Multiple linear regression analysis showed that patients with negative attitudes towards participation in decision-making ( P =0.023) and those who had rural insurance ( P =0.017) had significantly lower SDM-Q-9 scores than those with positive attitudes and those with medical insurance. Patients who were more satisfied with their medical service had higher SDM-Q-9 scores ( P <0.05). Conclusion Patients with glaucoma presented a high level of shared decision-making. Patients’ attitudes towards participating in decision-making, the payment method of medical expenses, and the level of satisfaction with medical services are factors that influence their level of participation in shared decision-making.

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“…This should be followed by discussions that help patients and their caregivers consider their choice in the context of their values and preferences (16). Yet, few older adults experience shared decision making (17). Nephrologists often avoid discussing prognosis and delay treatment discussions until decisions are imminent, perhaps owing to beliefs that patient treatment preferences are unstable and influenced by evolving symptoms (18).…”

Section: Introductionmentioning

confidence: 99%

Treatment Decision Making for Older Kidney Patients during COVID-19

Porteny

Gonzales

Aufort

et al. 2022

CJASN

Self Cite

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Background and objectivesCoronavirus disease 2019 (COVID-19) disrupted medical care across health care settings for older patients with advanced CKD. Understanding how shared decision making for kidney treatment decisions was influenced by the uncertainty of an evolving pandemic can provide insights for supporting shared decision making through the current and future public health crises.Design, setting, participants, & measurementsWe performed thematic and narrative analyses of semistructured interviews with patients (CKD stages 4 and 5, age 70+), care partners, and clinicians from Boston, Portland (Maine), San Diego, and Chicago from August to December 2020.ResultsWe interviewed 76 participants (39 patients, 17 care partners, and 20 clinicians). Among patient participants, 13 (33%) patients identified as Black, and seven (18%) had initiated dialysis. Four themes with corresponding subthemes emerged related to treatment decision making and the COVID-19 pandemic: (1) adapting to changed educational and patient engagement practices (patient barriers to care and new opportunities for telemedicine); (2) reconceptualizing vulnerability (clinician awareness of illness severity increased and limited discussions of patient COVID-19 vulnerability); (3) embracing home-based dialysis but not conservative management (openness to home-based modalities and limited discussion of conservative management and advanced care planning); and (4) satisfaction and safety with treatment decisions despite conditions of uncertainty.ConclusionsAlthough clinicians perceived greater vulnerability among older patients CKD and more readily encouraged home-based modalities during the COVID-19 pandemic, their discussions of vulnerability, advance care planning, and conservative management remained limited, suggesting areas for improvement. Clinicians reported burnout caused by the pandemic, increased time demands, and workforce limitations, whereas patients remained satisfied with their treatment choices despite uncertainty.Clinical Trial registry name and registration number: Decision Aid for Renal Therapy (DART), NCT03522740

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Shared Decision Making Among Older Adults With Advanced CKD

Cited by 16 publications

References 61 publications

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study

Patient-Centered Outcomes With a Multidisciplinary CKD Care Team Approach: An Observational Study

Factors Influencing Participation in Shared Decision-Making Among Patients with Glaucoma in China: A Cross-Sectional Study

Treatment Decision Making for Older Kidney Patients during COVID-19

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