Patients with CKD have limited success with shared decision-making
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Key takeaways:
- In a survey, 91.8% of patients reported they participated in care planning, while 67.2% participated in discussing medication changes.
- Patients said motivational interviewing techniques were rarely used.
Patients with chronic kidney disease have limited opportunities to engage in shared-decision-making with their physicians, according to a published Danish study.
“Research on shared decision making (SDM) in chronic kidney disease has focused almost exclusively on the modality of kidney replacement treatment,” Dorinde E.M. van der Horst, MD, of the department of internal medicine, St. Antonius Hospital, Nieuwegein, Denmark, and colleagues wrote. “We explored what other CKD decisions are recognized by patients, what their preferences and experiences are regarding these decisions, and how decisions are made during their interactions with medical care professionals.”
Data derived from van der Horst DEM, et al. Am J Kidney Dis.doi:10.1053/j.ajkd.2023.04.012.
A number of decisions make by physicians regarding CKD care deal with preserving kidney function. But patients face other issues as they reach heightened stages of the disease, according to the researchers.
“ [A]n abundance of other decisions are made in the management of CKD, starting from diagnosis and during the progression toward kidney failure,” the researchers wrote. “Many of these decisions relate to the aim of slowing down kidney function deterioration and the prevention of cardiovascular disease. They are often considered routine care decisions, including decisions regarding lifestyle, long-term medication and planning of care.
“Although these ‘common CKD decisions’ can be viewed as relatively minor when compared [with] the [kidney replacement therapy] decision, they do impact patients’ daily life,” the researchers continued.
SDM can become more important for patients with CKD “because it can help improve the fit between care and patient circumstances, enhance the patient-clinician relationship, and activate patients and increase their disease knowledge,” the researchers wrote. “Ultimately, these factors may stimulate therapy adherence and treatment efficacy.”
The researchers surveyed 122 patients with CKD who were receiving outpatient care in one of two Dutch hospitals. Using the Control Preferences Scale survey, patients in the study were asked about their preferred roles for treatment decisions.
The survey results showed that patients experienced a decisional role in a number of decisions “that did or did not match their preferred role,” the researchers wrote.
Specifically, among the 122 patients surveyed, 112 (91.8%) reported they participated in care planning, 82 (67.2%) were involved in discussing medication changes, and 59 of 122 (48.3%) patients talked about lifestyle changes with their physician.
“Of the 357 reported decisions in total, patients preferred that clinicians mostly (125 of 357) or fully (101 of 357) make the decisions,” van der Horst and colleagues wrote. “For 116 decisions, they preferred a shared decisional role.
“For 151 of 357 decisions, the patients’ preferences did not match their experiences,” the researchers wrote. “Decisions were experienced as ‘less shared/patient-directed’ (76 of 357) or ‘more shared/patient-directed’ (75 of 357) than preferred,” they wrote.
In the survey, patients said motivational interviewing techniques were rarely used.
“We identified multiple discrepancies between preferred, experienced and observed SDM in health care visits for CKD,” the researchers concluded. “Although patients varied in their preferred decisional role, a considerable number of patients expressed a preference for shared decision making for many decisions. However, SDM behavior during the health care visits was observed infrequently.”
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