Patient education increases shared decision-making among older adults with advanced CKD
Click Here to Manage Email Alerts
Among older adults with advanced chronic kidney disease, those who knew the range of kidney treatment options or attended an educational class about their options were more likely to engage in shared decision-making, according to a study.
In their findings published in the American Journal of Kidney Disease, experts suggest using decision aids could improve shared decision-making (SDM) outcomes.
“Older adults with advanced kidney disease face difficult treatment decisions. Dialysis offers uncertain survival benefits but has significant quality of life implications. SDM may help patients choose treatment options that best align with their goals and values,” Rebecca Frazier, MD, from the division of nephrology and hypertension in the department of medicine at the Center for Translational Metabolism and Health at the Institute for Public Health and Medicine at Northwestern University, and colleagues wrote. They added, “To improve understanding of SDM among older adults with advanced CKD, we examined SDM in nephrology clinics from four geographically diverse sites across the United States using baseline data from the Decision Aid for Renal Therapy (DART) Trial.”
In a cross-sectional, observational study, researchers analyzed the survey responses 350 older adults (mean age was 78 years; 58% were male; 13% identified as Black; 48% had diabetes) with advanced kidney disease who participated in DART Trial between 2018 and 2019. Participants were at least 70 years old and were from Boston, Chicago, San Diego or Portland (Maine).
The survey consisted of a Nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Participants scored each of the nine statements on a scale of 0 (strongly disagree) to 5 (strongly agree). Researchers standardized scores to a scale from 0 to 100 points, in which higher scores indicated a greater SDM.
Using multivariable linear regression models, researchers examined the relationship between SDM and predictors. Predictors included decisional readiness factors, treatment options education and care partner support.
The mean SDM-Q-9 score was 52, and agreement scores ranged for the SDM item with 41% of participants agreeing that “my doctor and I selected a treatment option together” to 73% agreeing that “my doctor told me that there are different options for treating my medical condition.”
Greater SDM corresponded with participants who were “well informed” and “very well informed” about various kidney treatment options, who had a higher decisional certainty and who attended kidney treatment option classes. However, 26% of participants in the study actually attended an educational class.
“In summary, many older patients with advanced CKD do not engage in SDM despite existing guidelines. Patients who reported being well informed about treatment options and attended kidney failure treatment options classes reported higher SDM, underscoring the importance of patient education for SDM,” Frazier and colleagues wrote. “Continuing to teach SDM in nephrology training programs, using decision aids that support SDM in clinic and preparing clinicians to engage in SDM may improve decisional outcomes for patients with advanced CKD.”
Collapse
Read more about
Click Here to Manage Email Alerts