New tool helps measure patients’ readiness to make decisions about starting dialysis

A new algorithm is a useful tool for measuring chronic kidney disease patients’ readiness for making decisions about initiating dialysis.

A new tool may help health professionals assess kidney disease patients’ readiness to make important life-changing treatment decisions around their dialysis care. The tool is described in a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

Patients with advanced chronic kidney disease are often faced with difficult medical choices, such as whether to start dialysis or undergo kidney transplantation, and many patients may not feel ready to make treatment decisions for a variety of reasons.

Investigators led by Suma Prakash, MD, FRCPC, MSc, from Case Western Reserve University, wondered whether a model called the “behavioral stage of change” model, which was originally used to help people quit smoking, might help patients with chronic kidney disease take action and make decisions about their dialysis options.

The team developed a tool based on the stage of change algorithm and used it in surveys with 55 patients with CKD. Sixty-five percent of patients were in a precontemplation/contemplation (thinking) stage and 35% were in a preparation/maintenance (acting) stage. The researchers found that the algorithm was a useful tool in measuring patients’ readiness for dialysis decision-making. Patients who had knowledge about their options and had fewer lifestyle barriers to home dialysis were more likely to be ready to make decisions. Also, clinicians who explained the available options for treatment helped increase patients’ readiness for decision-making.

“Focusing on understanding the decision-making process from patients’ perspectives allows us as medical professionals to help patients make timely decision about their options,” said Dr. Prakash. “Some potential impacts of reaching this goal are that patients might opt more for home dialysis options, and more patients may be able to start their preferred option in a non-urgent manner and not require admission to hospital to start dialysis.”

Study co-authors include Anna McGrail, Steven Lewis, MS, Jesse Schold, PhD, Mary Ellen Lawless, MA, Ashwini Sehgal, MD, and Adam Perzynski PhD.

Disclosures: Baxter provided a small grant for this study, which was also supported in parts by grants from the National Institutes of Health.

The article, entitled “Behavioral Stage of Change and Dialysis Decision Making,” appears online at http://cjasn.asnjournals.