More than half of patients report decisional conflict about kidney failure modalities
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A high prevalence of patients with chronic kidney disease report decisional conflict about kidney failure treatment, regardless of their risk of kidney failure, according to data published in Kidney Medicine.
Further, patients who attended treatment classes and reported high satisfaction with the discussions they had with care providers were less likely to experience decisional conflict about treatment.
“The primary purpose of the present study was to explore decisional conflict and identify associated sociodemographic, physical health, nephrology care/knowledge and psychosocial patient characteristics among adults with advanced CKD who had not implemented a kidney failure treatment decision,” Nicole DePasquale, PhD, MSPH, from the division of general internal medicine at Duke University School of Medicine, and colleagues wrote. They added, “By elucidating associations between nonmodifiable patient characteristics (eg, age) and decisional conflict, this study may facilitate identification of adults with advanced CKD who need or would benefit from additional support during the treatment decision-making process. Likewise, identifying associated modifiable patient characteristics (eg, CKD knowledge) may inform targeted intervention efforts to reduce decisional conflict and its downstream effects.”
In a cross-sectional study, researchers evaluated decisional conflict among 427 adults (the mean age was 71.6 years; 60% were women; 97% were non-Hispanic white) with advanced CKD, none of whom had a history of dialysis or transplantation, and a subset of 171 adults most at risk of kidney failure within 2 years.
Researchers used the Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) screening test to determine each patient’s decisional conflict about kidney failure treatment modalities. Patients answered “yes” or “no” to questions regarding kidney care in which “yes” equaled a score of 1 (no decisional conflict) and “no” or “don’t know” equaled a score of 0 (decisional conflict). Researchers then added the scores that ranged from 0 to 4. A score of 4 was considered perfect, and scores less than 3 meant providers should help patients make decisions about their care.
With a survey and electronic health records, researchers identified patients’ sociodemographic, physical health, nephrology care knowledge and psychosocial characteristics.
Using multivariable logistic regression, researchers measured the relationship between participant characteristics and decisional conflict. Analyses were repeated among the subgroup of patients.
Overall, 76% of patients reported treatment-related decisional conflict. Analyses revealed that patients who reported complete satisfaction with patient-kidney team treatment discussions and attended treatment education classes had 84% and 62% lower odds of decisional conflict. Additionally, those with greater treatment-related decision self-efficacy were also less likely to report decisional conflict. The subset group showed that decisional conflict was prevalent among patients with CKD, regardless of the progression risk.
“Efforts to reduce decisional conflict should focus on timely treatment education, person-centered treatment discussions and incorporation of decision self-efficacy–enhancing strategies into decision support mechanisms,” DePasquale and colleagues wrote.
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