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van Eck van der Sluijs A, Vonk S, Bonenkamp AA, Prantl K, Riemann AT, van Jaarsveld BC, Abrahams AC. Value of patient decision aids for shared decision-making in kidney failure. J Ren Care 2024; 50:15-23. [PMID: 37211923 DOI: 10.1111/jorc.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 04/02/2023] [Accepted: 04/19/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND It is unknown how often Dutch patient decision aids are used during kidney failure treatment modality education and what their impact is on shared decision-making. OBJECTIVES We determined the use of Three Good Questions, 'Overviews of options', and Dutch Kidney Guide by kidney healthcare professionals. Also, we determined patient-experienced shared decision-making. Finally, we determined whether the experience of shared decision-making among patients changed after a training workshop for healthcare professionals. DESIGN Quality improvement study. PARTICIPANTS Healthcare professionals answered questionnaires regarding education/patient decision aids. Patients with estimated glomerular filtration rate <20 mL/min/1.73 m2 completed shared decision-making questionnaires. Data were analysed with one-way analysis of variance and linear regression. RESULTS Of 117 healthcare professionals, 56% applied shared decision-making by discussing Three Good Questions (28%), 'Overviews of options' (31%-33%) and Kidney Guide (51%). Of 182 patients, 61%-85% was satisfied with their education. Of worst scoring hospitals regarding shared decision-making, only 50% used 'Overviews of options'/Kidney Guide. Of best scoring hospitals 100% used them, needed less conversations (p = 0.05), provided information about all treatment options and more often provided information at home. After the workshop, patients' shared decision-making scores remained unchanged. CONCLUSIONS The use of specifically developed patient decision aids during kidney failure treatment modality education is limited. Hospitals that did use them had higher shared decision-making scores. However, the degree of shared decision-making experienced by patients remained unchanged after healthcare professionals were trained on shared decision-making and the implementation of patient decision aids.
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Affiliation(s)
| | - Sanne Vonk
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anna A Bonenkamp
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association (NVN), Bussum, the Netherlands
| | - Aase T Riemann
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Research Institute Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Diapriva Dialysis Centre, Amsterdam, the Netherlands
| | - Alferso C Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
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Bekker HL, Winterbottom AE, Gavaruzzi T, Finderup J, Mooney A. Decision aids to assist patients and professionals in choosing the right treatment for kidney failure. Clin Kidney J 2023; 16:i20-i38. [PMID: 37711634 PMCID: PMC10497379 DOI: 10.1093/ckj/sfad172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 09/16/2023] Open
Abstract
Background Kidney services vary in the way they involve people with kidney failure (PwKF) in treatment decisions as management needs change. We discuss how decision-science applications support proactively PwKF to make informed decisions between treatment options with kidney professionals. Methods A conceptual review of findings about decision making and use of decision aids in kidney services, synthesized with reference to: the Making Informed Decisions-Individually and Together (MIND-IT) multiple stakeholder decision makers framework; and the Medical Research Council-Complex Intervention Development and Evaluation research framework. Results This schema represents the different types of decision aids that support PwKF and professional reasoning as they manage kidney disease individually and together; adjustments at micro, meso and macro levels supports integration in practice. Conclusion Innovating services to meet clinical guidelines on enhancing shared decision making processes means enabling all stakeholders to use decision aids to meet their goals within kidney pathways at individual, service and organizational levels.
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Affiliation(s)
- Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Department of Public Health, Aarhus University, Denmark
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
| | - Anna E Winterbottom
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - Teresa Gavaruzzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Jeanette Finderup
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrew Mooney
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
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Cardona M, Lewis ET, Bannach-Brown A, Ip G, Tan J, Koreshe E, Head J, Lee JJ, Rangel S, Bublitz L, Forbes C, Murray A, Marechal-Ross I, Bathla N, Kusnadi R, Brown PG, Alkhouri H, Ticehurst M, Lovell NH. Development and preliminary usability testing of an electronic conversation guide incorporating patient values and prognostic information in preparation for older people's decision-making near the end of life. Internet Interv 2023; 33:100643. [PMID: 37521519 PMCID: PMC10382674 DOI: 10.1016/j.invent.2023.100643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 05/21/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023] Open
Abstract
Initiating end-of-life conversations can be daunting for clinicians and overwhelming for patients and families. This leads to delays in communicating prognosis and preparing for the inevitable in old age, often generating potentially harmful overtreatment and poor-quality deaths. We aimed to develop an electronic resource, called Communicating Health Alternatives Tool (CHAT) that was compatible with hospital medical records software to facilitate preparation for shared decision-making across health settings with older adults deemed to be in the last year of life. The project used mixed methods including: literature review, user-directed specifications, web-based interface development with authentication and authorization; clinician and consumer co-design, iterative consultation for user testing; and ongoing developer integration of user feedback. An internet-based conversation guide to facilitate clinician-led advance care planning was co-developed covering screening for short-term risk of death, patient values and preferences, and treatment choices for chronic kidney disease and dementia. Printed summary of such discussion could be used to begin the process in hospital or community health services. Clinicians, patients, and caregivers agreed with its ease of use and were generally accepting of its contents and format. CHAT is available to health services for implementation in effectiveness trials to determine whether the interaction and documentation leads to formal decision-making, goal-concordant care, and subsequent reduction of unwanted treatments at the end of life.
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Affiliation(s)
- Magnolia Cardona
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
- Gold Coast Hospital and Health Service, Professorial Unit, Southport, Australia
| | - Ebony T. Lewis
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Alex Bannach-Brown
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Genevieve Ip
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Janice Tan
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Eyza Koreshe
- InsideOut Institute, Faculty of Medicine & Health, The University of Sydney, Camperdown, Australia
| | - Joshua Head
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Jin Jie Lee
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Shirley Rangel
- Gold Coast Hospital and Health Service, Professorial Unit, Southport, Australia
| | - Lorraine Bublitz
- Gold Coast Hospital and Health Service, Professorial Unit, Southport, Australia
| | - Connor Forbes
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Amanda Murray
- Institute for Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Isabella Marechal-Ross
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Nikita Bathla
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Ruth Kusnadi
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Peter G. Brown
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Hatem Alkhouri
- Agency for Clinical Innovation, Emergency Care Institute, Chatswood, Australia
| | - Maree Ticehurst
- School of Population Health, Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
- Mark Moran Aged Care, Little Bay, New South Wales, Australia
| | - Nigel H. Lovell
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
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Kidney Failure Patients' Perceptions and Definitions of Health: A Qualitative Study. Kidney Med 2023; 5:100603. [PMID: 36925662 PMCID: PMC10011499 DOI: 10.1016/j.xkme.2023.100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Rationale & Objective Patients with kidney failure who have used multiple treatment modalities are a unique source of information for how different options may best fit their values. We aimed to understand how people interpret their health and kidney failure treatment experience to inform providers who facilitate shared decision-making conversations. Study Design This qualitative, interpretive phenomenological study explores how patients with kidney failure interpret health throughout their treatment trajectory. Setting & Participants We recruited a purposive sample of patients who had used 3 or more kidney failure treatment options, including transplant and dialysis from transplant clinics and online support groups, for semi-structured interviews. Eligible participants were over 18 and spoke English for a total of 7 current transplant, 10 current home dialysis, and 1 current in-center patient. Analytical Approach A 6-step iterative process of data analysis occurred concurrently with data collection. Results Half of the 18 participants were Black; 67% were women. Three interrelated themes emerged from interviews: ability to engage in meaningful activities; working for balance; and living in context. Participants evaluated health according to their ability to engage in meaningful activities while balancing their emotional and physical needs with their life goals. When their social and treatment environments supported their autonomy, participants also considered themselves healthy. Limitations The inclusion of only English-speaking patients limits the transferability of findings. A longitudinal design, repeated interviews, observation, and dyadic interviews would increase the health care providers' understanding and interpretation of health. Conclusions The themes demonstrated patients evaluated health based on ability to engage in meaningful activities while maintaining balance. The treatment context, particularly how health care providers responded to patients' physiological experience, autonomy, and power, influenced interpretation of patient treatment experiences. Integrating patient interpretations of health with quantitative measures of treatment effectiveness can help health care providers better partner with patients to provide effective care for kidney failure.
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Frazier R, Levine S, Porteny T, Tighiouart H, Wong JB, Isakova T, Koch-Weser S, Gordon EJ, Weiner DE, Ladin K. Shared Decision Making Among Older Adults With Advanced CKD. Am J Kidney Dis 2022; 80:599-609. [PMID: 35351579 DOI: 10.1053/j.ajkd.2022.02.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/09/2022] [Indexed: 02/02/2023]
Abstract
RATIONALE & OBJECTIVE Older adults with advanced chronic kidney disease (CKD) face difficult decisions about dialysis initiation. Although shared decision making (SDM) can help align patient preferences and values with treatment options, the extent to which older patients with CKD experience SDM remains unknown. STUDY DESIGN A cross-sectional analysis of patient surveys examining decisional readiness, treatment options education, care partner support, and SDM. SETTING & PARTICIPANTS Adults aged 70 years or older from Boston, Chicago, San Diego, or Portland (Maine) with nondialysis advanced CKD. PREDICTORS Decisional readiness factors, treatment options education, and care partner support. OUTCOMES Primary: SDM measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) instrument, with higher scores reflecting greater SDM. Exploratory: Factors associated with SDM. ANALYTICAL APPROACH We used multivariable linear regression models to examine the associations between SDM and predictors, controlling for demographic and health factors. RESULTS Among 350 participants, mean age was 78 ± 6 years, 58% were male, 13% identified as Black, and 48% had diabetes. Mean SDM-Q-9 score was 52 ± 28. SDM item agreement ranged from 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." In multivariable analysis adjusted for demographic characteristics, lower estimated glomerular filtration rate, and diabetes, being "well informed" and "very well informed" about kidney treatment options, having higher decisional certainty, and attendance at a kidney treatment options class were independently associated with higher SDM-Q-9 scores. LIMITATIONS The cross-sectional study design limits the ability to make temporal associations between SDM and the predictors. CONCLUSIONS Many older patients with CKD do not experience SDM when making dialysis decisions, emphasizing the need for greater access to and delivery of education for individuals with advanced CKD.
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Affiliation(s)
- Rebecca Frazier
- Division of Nephrology and Hypertension, Department of Medicine, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois; Jesse Brown Veterans Administration Medical Center, Chicago, Illinois.
| | - Sarah Levine
- William B. Schwartz MD Division of Nephrology, Tufts University School of Medicine, Boston, Massachusetts
| | - Thalia Porteny
- Research on Ethics, Aging, and Community Health (REACH Lab) and Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts; Tufts Clinical and Translational Science Institute, Tufts University, Tufts University School of Medicine, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Department of Medicine, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois
| | - Susan Koch-Weser
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Elisa J Gordon
- Department of Surgery-Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel E Weiner
- William B. Schwartz MD Division of Nephrology, Tufts University School of Medicine, Boston, Massachusetts
| | - Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH Lab) and Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
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Buur LE, Finderup J, Søndergaard H, Kannegaard M, Madsen JK, Bekker HL. Shared decision-making and planning end-of-life care for patients with end-stage kidney disease: a protocol for developing and testing a complex intervention. Pilot Feasibility Stud 2022; 8:226. [PMID: 36195969 PMCID: PMC9533563 DOI: 10.1186/s40814-022-01184-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Internationally, it has been stressed that advance care planning integrated within kidney services can lead to more patients being involved in decisions for end-of-life care. In Denmark, there is no systematic approach to advance care planning and end-of-life care interventions within kidney services. A shared decision-making intervention for planning end-of-life care may support more effective treatment management between patients with end-stage kidney disease, their relatives and the health professionals. The purpose of this research is to find evidence to design a shared decision-making intervention and test its acceptability to patients with end-stage kidney disease, their relatives, and health professionals in Danish kidney services. Methods This research project will be conducted from November 2020 to November 2023 and is structured according to the UK Medical Research Council framework for complex intervention design and evaluation research. The development phase research includes mixed method surveys. First, a systematic literature review synthesising primary empirical evidence of patient-involvement interventions for patients with end-stage kidney disease making end-of-life care decisions will be conducted. Second, interview methods will be carried out with patients with end-stage kidney disease, relatives, and health professionals to identify experiences of involvement in decision-making and decisional needs when planning end-of-life care. Findings will inform the co-design of the shared decision-making intervention using an iterative process with our multiple-stakeholder steering committee. A pilot test across five kidney units assessing if the shared decision-making intervention is acceptable and feasible to patients, relatives, and health professionals providing services to support delivery of care in kidney services. Discussion This research will provide evidence informing the content and design of a shared decision-making intervention supporting patient-professional planning of end-of-life care for patients with end-stage kidney disease, and assessing its acceptability and feasibility when integrated within Danish kidney units. This research is the first step to innovating the involvement of patients in end-of-life care planning with kidney professionals.
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Affiliation(s)
- Louise Engelbrecht Buur
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,ResCenPI-Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark. .,Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.,ResCenPI-Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Kristian Madsen
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Hilary Louise Bekker
- ResCenPI-Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Science, University of Leeds, Leeds, UK
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Engels N, de Graav GN, van der Nat P, van den Dorpel M, Stiggelbout AM, Bos WJ. Shared decision-making in advanced kidney disease: a scoping review. BMJ Open 2022; 12:e055248. [PMID: 36130746 PMCID: PMC9494569 DOI: 10.1136/bmjopen-2021-055248] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To provide a comprehensive overview of interventions that support shared decision-making (SDM) for treatment modality decisions in advanced kidney disease (AKD). To provide summarised information on their content, use and reported results. To provide an overview of interventions currently under development or investigation. DESIGN The JBI methodology for scoping reviews was followed. This review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. DATA SOURCES MEDLINE, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO, PROSPERO and Academic Search Premier for peer-reviewed literature. Other online databases (eg, clinicaltrials.gov, OpenGrey) for grey literature. ELIGIBILITY FOR INCLUSION Records in English with a study population of patients >18 years of age with an estimated glomerular filtration rate <30 mL/min/1.73 m2. Records had to be on the subject of SDM, or explicitly mention that the intervention reported on could be used to support SDM for treatment modality decisions in AKD. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened and selected records for data extraction. Interventions were categorised as prognostic tools (PTs), educational programmes (EPs), patient decision aids (PtDAs) or multicomponent initiatives (MIs). Interventions were subsequently categorised based on the decisions they were developed to support. RESULTS One hundred forty-five interventions were identified in a total of 158 included records: 52 PTs, 51 EPs, 29 PtDAs and 13 MIs. Sixteen (n=16, 11%) were novel interventions currently under investigation. Forty-six (n=46, 35.7%) were reported to have been implemented in clinical practice. Sixty-seven (n=67, 51.9%) were evaluated for their effects on outcomes in the intended users. CONCLUSION There is no conclusive evidence on which intervention is the most efficacious in supporting SDM for treatment modality decisions in AKD. There is a lot of variation in selected outcomes, and the body of evidence is largely based on observational research. In addition, the effects of these interventions on SDM are under-reported.
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Affiliation(s)
- Noel Engels
- Department of Shared Decision-Making and Value-Based Health Care, Santeon, Utrecht, The Netherlands
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Paul van der Nat
- Department of Value-Based Health Care, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan Bos
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Value-Based Health Care, Sint Antonius Hospital, Nieuwegein, The Netherlands
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8
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Yu X, Nakayama M, Wu MS, Kim YL, Mushahar L, Szeto CC, Schatell D, Finkelstein FO, Quinn RR, Duddington M. Shared Decision-Making for a Dialysis Modality. Kidney Int Rep 2022; 7:15-27. [PMID: 35005310 PMCID: PMC8720663 DOI: 10.1016/j.ekir.2021.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of kidney failure continues to rise globally. Dialysis is a treatment option for individuals with kidney failure; after the decision to initiate dialysis has been made, it is critical to involve individuals in the decision on which dialysis modality to choose. This review, based on evidence arising from the literature, examines the role of shared decision-making (SDM) in helping those with kidney failure to select a dialysis modality. SDM was found to lead to more people with kidney failure feeling satisfied with their choice of dialysis modality. Individuals with kidney failure must be cognizant that SDM is an active and iterative process, and their participation is essential for success in empowering them to make decisions on dialysis modality. The educational components of SDM must be easy to understand, high quality, unbiased, up to date, and targeted to the linguistic, educational, and cultural needs of the individual. All individuals with kidney failure should be encouraged to participate in SDM and should be involved in the design and implementation of SDM approaches.
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Affiliation(s)
- Xueqing Yu
- Division of Nephrology, Guangdong Provincial People’s Hospital, Guangzhou, People’s Republic of China
- Correspondence: Xueqing Yu, Division of Nephrology, Guangdong Provincial People’s Hospital, 106th, Zhongshan Road II, Guangzhou 510080, People’s Republic of China.
| | | | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Lily Mushahar
- Department of Nephrology, Hospital Tuanku Ja'afar, Seremban, Malaysia
| | - Cheuk Chun Szeto
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Dori Schatell
- Medical Education Institute, Inc., Madison, Wisconsin, USA
| | | | - Robert R. Quinn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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9
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Barrett TM, Green JA, Greer RC, Ephraim PL, Peskoe S, Pendergast JF, Hauer CL, Strigo TS, Norfolk E, Bucaloiu ID, Diamantidis CJ, Hill-Briggs F, Browne T, Jackson GL, Boulware LE. Preferences for and Experiences of Shared and Informed Decision Making Among Patients Choosing Kidney Replacement Therapies in Nephrology Care. Kidney Med 2021; 3:905-915.e1. [PMID: 34939000 PMCID: PMC8664702 DOI: 10.1016/j.xkme.2021.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) can progress rapidly, and patients are often unprepared to make kidney failure treatment decisions. We aimed to better understand patients' preferences for and experiences of shared and informed decision making (SDM) regarding kidney replacement therapy before kidney failure. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Adults receiving nephrology care at CKD clinics in rural Pennsylvania. PREDICTORS Estimated glomerular filtration rate, 2-year risk for kidney failure, duration and frequency of nephrology care, and preference for SDM. OUTCOMES Occurrence and extent of kidney replacement therapy discussions and participants' satisfaction with those discussions. ANALYTIC APPROACH Multivariable logistic regression to quantify associations between participants' characteristics and whether they had discussions. RESULTS The 447 study participants had a median age of 72 (IQR, 64-80) years and mean estimated glomerular filtration rate of 33 (SD, 12) mL/min/1.73 m2. Most (96%) were White, high school educated (67%), and retired (65%). Most (72%) participants preferred a shared approach to kidney treatment decision making, and only 35% discussed dialysis or transplantation with their kidney teams. Participants who had discussions (n = 158) were often completely satisfied (63%) but infrequently discussed potential treatment-related impacts on their lives. In multivariable analyses, those with a high risk for kidney failure within 2 years (OR, 3.24 [95% CI, 1.72-6.11]; P < 0.01), longer-term nephrology care (OR, 1.12 [95% CI, 1.05-1.20] per 1 additional year; P < 0.01), and more nephrology visits in the prior 2 years (OR, 1.34 [95% CI, 1.20-1.51] per 1 additional visit; P < 0.01) had higher odds of having discussed dialysis or transplantation. LIMITATIONS Single health system study. CONCLUSIONS Most patients preferred sharing CKD treatment decisions with their providers, but treatment discussions were infrequent and often did not address key treatment impacts. Longitudinal nephrology care and frequent visits may help ensure that patients have optimal SDM experiences.
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Affiliation(s)
- Tyler M. Barrett
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Jamie A. Green
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
- Kidney Health Research Institute, Danville, PA
| | - Raquel C. Greer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Patti L. Ephraim
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Jane F. Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Chelsie L. Hauer
- Center for Clinical Innovation, Institute for Advanced Application, Danville, PA
| | - Tara S. Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Evan Norfolk
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Ion Dan Bucaloiu
- Department of Nephrology, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Clarissa J. Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
- Division of Nephrology, Duke University School of Medicine, Durham, NC
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC
| | - George L. Jackson
- Center for Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
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10
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Affiliation(s)
- Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Research Centre for Patient Involvement, Aarhus University & The Central Denmark, Region, Aarhus N, Denmark
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11
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Schellartz I, Ohnhaeuser T, Mettang T, Scholten N. Information about different treatment options and shared decision making in dialysis care - a retrospective survey among hemodialysis patients. BMC Health Serv Res 2021; 21:673. [PMID: 34238295 PMCID: PMC8268609 DOI: 10.1186/s12913-021-06599-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hemodialysis (HD) and peritoneal dialysis (PD) are equivalent treatment alternatives for patients with end stage renal disease. In Germany, there is a legal obligation to inform every patient about all treatment alternatives and their possible harms and benefits. However, there is a low utilization of PD. Therefore, the question arises, whether HD patients perceive that they were informed about different dialysis options. We further investigate, if personal characteristics of informed and non-informed patients vary, and if both groups experienced the decision for their dialysis treatment as shared decision making (SDM). Methods The database was a nationwide postal survey of 590 HD patients from two statutory health insurers in Germany. Participants were asked whether they have been informed about both dialysis options. A logistic regression model examines impact factors on this information. We investigate differences in the German version of the 9-item SDM Questionnaire (SDM-Q-9) between informed and non-informed patients with a multivariate linear regression model. Results 56 % of the respondents reported they had been informed about different dialysis treatment options. Patients older than 65 had a 61 % lower chance than patients ≤ 65 for this information (p < 0.001). High educated patients had a 47 % higher chance for this information than patients with low education level (p = 0.030). Informed patients rated a higher SDM-Q-9 scores than non-informed patients (76.9 vs. 44.2; p < 0.001). Non-informed patients showed high values in those SDM-Q-9 items which had no regard to different treatment options. Conclusions A great proportion of HD patients – mostly elderly patients and patients with a low education level – did not perceive that they were informed about different dialysis options before dialysis was initiated. The current obligation to provide information about all treatment alternatives in Germany is a first step to assure the unselected access to different treatment options. But it has not reached routine application in health care yet. Information about different treatment options can pave the way for SDM. While SDM is considered to be a valuable tool in clinical medicine, there is still room for improvement for its successful implementation when it comes to decision making on different dialysis treatment options. Trial registration The MAU-PD study (Multidimensional analysis of causes for the low prevalence of ambulatory peritoneal dialysis in Germany) is registered at the German Clinical Trials Register.
DRKS-ID: DRKS00012555 Link: https://www.drks.de/drks_web/setLocale_EN.do. Date of Registration in DRKS: 2018/01/04.
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Affiliation(s)
- Isabell Schellartz
- Faculty of Human Sciences, Faculty of Medicine, Institute of Medical Sociology, University of Cologne, Health Services Research and Rehabilitation Science (IMVR), Eupener Str. 129, 50933, Cologne, Germany.
| | - Tim Ohnhaeuser
- Faculty of Human Sciences, Faculty of Medicine, Institute of Medical Sociology, University of Cologne, Health Services Research and Rehabilitation Science (IMVR), Eupener Str. 129, 50933, Cologne, Germany
| | | | - Nadine Scholten
- Faculty of Human Sciences, Faculty of Medicine, Institute of Medical Sociology, University of Cologne, Health Services Research and Rehabilitation Science (IMVR), Eupener Str. 129, 50933, Cologne, Germany
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12
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Amir N, McCarthy HJ, Tong A. A working partnership: A review of shared decision-making in nephrology. Nephrology (Carlton) 2021; 26:851-857. [PMID: 34010487 DOI: 10.1111/nep.13902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
Patients with chronic kidney disease are required to make difficult decisions, negotiating between the risks, burdens and benefits for any proposed course. This process can be extremely challenging, since these decisions involve inherent risks, which can impact on survival and quality of life. Shared decision-making offers a patient-centred approach in partnering with patients to make decisions about their treatment, which reflect their values and preferences. Shared decision-making can improve patient preparedness, motivation, satisfaction, and adherence to the treatment or decision agreed upon. In this review article, we outline the key principles of shared decision-making, and provide a framework with communication strategies to facilitate shared decision-making. We highlight the broad range and context of decisions faced by patients in several areas of nephrology care and discuss patient-important outcomes, priorities and motivations that underpin their decision-making. Preserving patient autonomy through shared decision-making ensures close consideration of patient preferences to enhance satisfaction with the decision reached and optimize outcomes important to patients.
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Affiliation(s)
- Noa Amir
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hugh J McCarthy
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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13
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Paduca A, Arnaut O, Beschieru E, Lundmark PO, Bruenech JR. Shared decision making and patients satisfaction with strabismus care-a pilot study. BMC Med Inform Decis Mak 2021; 21:109. [PMID: 33771137 PMCID: PMC7995717 DOI: 10.1186/s12911-021-01469-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strabismus is a complex disease that has various treatment approaches each with its own advantages and drawbacks. In this context, shared decisions making (SDM) is a communication process with the provider sharing all the relevant treatment alternatives, all the benefits, and risks of each procedure, while the patient shares all the preferences and values regarding his/her choices. In that way, SDM is a bidirectional process that goes beyond the typical informed consent. Therefore, it is known a little of the extent to which SDM influences the satisfaction with the treatment outcome along with strabismus patients. To study this correlation, an SDM-Q-9 questionnaire was provided within surgical consultations where treatment decisions were made; the SDM-Q-9 aims to assess the relationship between the post-operative patient's satisfaction and their SMD score. METHODS The study is considered a prospective observational pilot study. Eligible patients were adult patients diagnosed with strabismus, who had multiple treatment options, were given at the right of choice without being driven into a physician's preference. Ninety-three strabismus patients were asked to fill out the SDM-Q-9 questionnaire related to their perception of SDM during the entire period of strabismus treatment. After the treatment, patients were asked to rate their satisfaction level with the surgical outcome as excellent, good, fair, and poor. Descriptive statistics and the linear regression statistical tests (Spearman, Mann Whitney U, and Kriskal-Wallis) were used as analysis tools. RESULTS The average age of the participants was 24, where 50.6% were women. The mean SDM-Q-9 score among patients was 32 (IQR = 3). The postoperative patient satisfaction was rated as being excellent by 16 (17.2%) patients, good by 38 (40.9%), fair by 32 (34.4%), and poor by 7 patients (7.5%). Data analysis by linear regression statistical tests showed a positive correlation between the SDM-Q-9 score and the patient satisfaction related to the surgery outcome (B = 0.005, p < 0.001). Criteria in assessing patients' satisfaction were age, gender, and strabismus type. A positive correlation between SDM and real satisfaction (r = 0.834, p < 0.01) was found with age, and no significant relationship was found while taking into consideration the responder's gender and the strabismus type. CONCLUSIONS Assessing patient satisfaction after choosing a treatment for strabismus method helped us evaluate the gaps in constructive dialogue that would lead to a positive outcome for both patient and clinician. The correlation between the SDM process and the patients' satisfaction with surgery outcome, adjusted by age, has been established. These findings can serve as a springboard to further communicative improvements related to the SDM process and between patients and physicians, thereby consequently leading to patients' satisfaction raise in strabismus care. The study underlines the importance of further analysis and validation of on-ground interactions among the adolescent and adult patients and the clinicians across the strabismus management trajectory. A multicentral study and its validation will follow.
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Affiliation(s)
- Ala Paduca
- Faculty of Health and Social Science, South Eastern University Norway, Kongsberg, Norway. .,Ophthalmology Department, Universitatea de Stat de Medicina si Farmacie "Nicolae Testemitanu″, Chişinău, Republic of Moldova.
| | - Oleg Arnaut
- Department of Human Physiology and Biophysics, Universitatea de Stat de Medicina si Farmacie "Nicolae Testemitanu", Chişinău, Republic of Moldova
| | - Eugeniu Beschieru
- Department of Surgery No.1 "N. Anestiadi", Universitatea de Stat de Medicina si Farmacie "Nicolae Testemitanu", Chişinău, Republic of Moldova
| | - Per Olof Lundmark
- Faculty of Health and Social Science, South Eastern University Norway, Kongsberg, Norway
| | - Jan Richard Bruenech
- Faculty of Health and Social Science, South Eastern University Norway, Kongsberg, Norway
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14
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Finderup J, Jensen JD, Lomborg K. Shared decision-making in dialysis choice has potential to improve self-management in people with kidney disease: A qualitative follow-up study. J Adv Nurs 2020; 77:1878-1887. [PMID: 33336465 DOI: 10.1111/jan.14726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022]
Abstract
AIMS To explore how patients remained involved in their treatment and care of their own health following a shared decision-making intervention for dialysis choice. DESIGN A follow-up study using semi-structured interviews. METHODS Individual interviews with 13 patients were conducted immediately following their participation in a shared decision-making intervention for dialysis choice and again 3 months after initiating dialysis. This study reports findings from the follow-up interviews 3 month after dialysis initiation. Data were collected from August 2017-February 2019 and analysed using systematic text condensation. RESULTS The analysis revealed five main findings, which indicated differing levels of: (a) involvement in the decision-making process; (b) involvement in treatment; (c) involvement in care of own health; (d) involvement of a relative; and (e) support from healthcare professionals. CONCLUSIONS Following the shared decision-making intervention, patients who chose home-based treatment had become more involved in their treatment and care of their own health. The involvement of relatives and support from healthcare professionals contributed positively to this. In contrast, patients who had chosen hospital-based treatment were less involved in their treatment. IMPACT Shared decision-making in dialysis choice has potential to improve self-management in people with kidney disease. However, support from healthcare professionals for patients and their relatives should be prioritized in an effort to increase all patients' involvement in their treatment and care of their own health.
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Affiliation(s)
- Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Research Centre for Patient Involvement, Aarhus University & The Central Denmark Region, Aarhus N, Denmark
| | - Jens Dam Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
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15
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Winterbottom AE, Mooney A, Russon L, Hipkiss V, Ziegler L, Williams R, Finderup J, Bekker HL. Kidney disease pathways, options and decisions: an environmental scan of international patient decision aids. Nephrol Dial Transplant 2020; 35:2072-2082. [PMID: 32830240 PMCID: PMC7716808 DOI: 10.1093/ndt/gfaa102] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/10/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Conservative management is recognized as an acceptable treatment for people with worsening chronic kidney disease; however, patients consistently report they lack understanding about their changing disease state and feel unsupported in making shared decisions about future treatment. The purpose of this review was to critically evaluate patient decision aids (PtDAs) developed to support patient-professional shared decision-making between dialysis and conservative management treatment pathways. METHODS We performed a systematic review of resources accessible in English using environmental scan methods. Data sources included online databases of research publications, repositories for clinical guidelines, research projects and PtDAs, international PtDA expert lists and reference lists from relevant publications. The resource selection was from 56 screened records; 17 PtDAs were included. A data extraction sheet was applied to all eligible resources, eliciting resource characteristics, decision architecture to boost/bias thinking, indicators of quality such as International Standards for Patient Decision Aids Standards checklist and engagement with health services. RESULTS PtDAs were developed in five countries; eleven were publically available via the Internet. Treatment options described were dialysis (n = 17), conservative management (n = 9) and transplant (n = 5). Eight resources signposted conservative management as an option rather than an active choice. Ten different labels across 14 resources were used to name 'conservative management'. The readability of the resources was good. Six publications detail decision aid development and/or evaluation research. Using PtDAs improved treatment decision-making by patients. Only resources identified as PtDAs and available in English were included. CONCLUSIONS PtDAs are used by some services to support patients choosing between dialysis options or end-of-life options. PtDAs developed to proactively support people making informed decisions between conservative management and dialysis treatments are likely to enable services to meet current best practice.
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Affiliation(s)
| | - Andrew Mooney
- Adult Renal Services, Lincoln Wing, St James University Hospital, Leeds, UK
| | | | - Vicki Hipkiss
- Bradford Renal Unit, Horton Wing, St Luke’s Hospital, West Yorkshire, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, School of Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Williams
- Adult Renal Services, Lincoln Wing, St James University Hospital, Leeds, UK
| | - Jeanette Finderup
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- ResCenPI, Research Centre for Patient Involvement, Aarhus University Central Denmark Region, Aarhus, Denmark
| | - Hilary L Bekker
- ResCenPI, Research Centre for Patient Involvement, Aarhus University Central Denmark Region, Aarhus, Denmark
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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16
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Evangelidis N, Sautenet B, Manera KE, Howell M, Craig JC, Viecelli AK, O'Lone E, Scholes‐Robertson N, Johnson DW, Cho Y, Tomson C, Wheeler DC, Tong A. Perspectives on blood pressure by patients on haemo‐ and peritoneal dialysis. Nephrology (Carlton) 2020; 26:62-69. [DOI: 10.1111/nep.13775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Benedicte Sautenet
- Service de Néphrologie, Hôpital Bretonneau, CHRU Tours, Université de Tours et Nantes, SPHERE‐ INSERM 1246 Tours France
| | - Karine E. Manera
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Jonathan C. Craig
- College of Medicine and Public Health, Flinders University Adelaide Australia
| | - Andrea K. Viecelli
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
| | - Emma O'Lone
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - Nicole Scholes‐Robertson
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
| | - David W. Johnson
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | - Yeoungjee Cho
- Department of Nephrology Princess Alexandra Hospital Brisbane Queensland Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | | | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney Sydney New South Wales Australia
- Centre for Kidney Research, The Children's Hospital at Westmead Sydney New South Wales Australia
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17
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Finderup J, Crowley A, Søndergaard H, Lomborg K. Involvement of patients with chronic kidney disease in research: A case study. J Ren Care 2020; 47:73-86. [PMID: 32869408 DOI: 10.1111/jorc.12346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Knowledge about best practices of patient involvement in research among patients with chronic kidney disease is sparse, with little information about barriers to and facilitators of this process. The purpose of this study is to evaluate the process and outcomes of patient involvement in a particular chronic kidney disease research project. OBJECTIVES To describe how patients with chronic kidney disease were involved in the research; to explain what occurred when patients with chronic kidney disease were involved; to identify facilitators of and barriers to patient involvement in research. PARTICIPANTS Two patients with chronic kidney disease who have both been involved in a previous research project. MEASUREMENTS A retrospective embedded case study of patient involvement in research with the shared decision-making and dialysis choice project inspired by Yin (2012, Case Study Methods), using document analysis and semistructured individual interviews. Data were analysed with specific research questions in mind. RESULTS Two patients participated in four research meetings covering all substudies of a research project and all six phases of the research process. Eight facilitators and barriers were identified. CONCLUSIONS Patients with chronic kidney disease were involved in all the six phases of the research process but were more highly involved in some phases than others. Important facilitators of patient involvement in chronic kidney disease research include working as a team, being a part of the process, and being prepared for the work. Important barriers to patient involvement include patient vulnerability and uremic symptoms, both of which must be taken into account.
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Affiliation(s)
- Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,ResCenPI - Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | | | | | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center, Copenhagen, Denmark
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18
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Finderup J, Lomborg K, Jensen JD, Stacey D. Choice of dialysis modality: patients' experiences and quality of decision after shared decision-making. BMC Nephrol 2020; 21:330. [PMID: 32758177 PMCID: PMC7409698 DOI: 10.1186/s12882-020-01956-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Patients with kidney failure experience a complex decision on dialysis modality performed either at home or in hospital. The options have different levels of impact on their physical and psychological condition and social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision-making for dialysis choice. Specific objectives were: 1) to measure decision quality as indicated by patients' knowledge, readiness and achieved preferences; and 2) to determine if patients experienced shared decision-making. METHOD A mixed methods descriptive study was conducted using both questionnaires and semi-structured interviews. Eligible participants were adults with kidney failure considering dialysis modality. The intervention, based on the Three-Talk model, consisted of a patient decision aid and decision coaching meetings provided by trained dialysis coordinators. The intervention was delivered to 349 patients as part of their clinical pathway of care. After the intervention, 148 participants completed the Shared Decision-Making Questionnaire and the Decision Quality Measurement, and 29 participants were interviewed. Concordance between knowledge, decision and preference was calculated to measure decision quality. Interview transcripts were analysed qualitatively. RESULTS The participants obtained a mean score for shared decision-making of 86 out of 100. There was no significant difference between those choosing home- or hospital-based treatment (97 versus 83; p = 0.627). The participants obtained a knowledge score of 82% and a readiness score of 86%. Those choosing home-based treatment had higher knowledge score than those choosing hospital-based treatment (84% versus 75%; p = 0.006) but no significant difference on the readiness score (87% versus 84%; p = 0.908). Considering the chosen option and the knowledge score, 83% of the participants achieved a high-quality decision. No significant difference was found for decision quality between those choosing home- or hospital-based treatment (83% versus 83%; p = 0.935). Interview data informed the interpretation of these results. CONCLUSIONS Although there was no control group, over 80% of participants exposed to the intervention and responded to the surveys experienced shared decision-making and reached a high-quality decision. Both participants who chose home- and hospital-based treatment experienced the intervention as shared decision-making and made a high-quality decision. Qualitative findings supported the quantitative results. TRIAL REGISTRATION The full trial protocol is available at ClinicalTrials. Gov ( NCT03868800 ). The study has been registered retrospectively.
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Affiliation(s)
- Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Aarhus N Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Dam Jensen
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Aarhus N Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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19
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Therkildsen SB, Hansen LH, Jensen LED, Finderup J. A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study. JMIR Form Res 2019; 3:e13786. [PMID: 31750836 PMCID: PMC6914284 DOI: 10.2196/13786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. OBJECTIVE The aim of this study was to uncover the applicability of the DG as a PDA. METHODS The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. RESULTS A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. CONCLUSIONS The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents' average age. Thus, the applicability of the DG cannot be definitively determined.
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Affiliation(s)
| | | | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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20
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Finderup J, Dam Jensen J, Lomborg K. Evaluation of a shared decision-making intervention for dialysis choice at four Danish hospitals: a qualitative study of patient perspective. BMJ Open 2019; 9:e029090. [PMID: 31630101 PMCID: PMC6803133 DOI: 10.1136/bmjopen-2019-029090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the 'Shared Decision-making and Dialysis Choice' (SDM-DC) intervention with regard to patients' experience and involvement. DESIGN Semistructured individual interviews and systematic text condensation for data analysis. SETTING The SDM-DC intervention was implemented and evaluated at four different hospitals in Denmark. PARTICIPANTS A total of 348 patients had received the SDM-DC intervention, and of these 29 patients were interviewed. INTERVENTIONS SDM-DC was designed for patients facing a choice of dialysis modality. The available modalities were haemodialysis and peritoneal dialysis, either performed by patients on their own or with help from a healthcare professional. The intervention was tailored to individual patients and consisted of three meetings with a dialysis coordinator who introduced a patient decision aid named 'Dialysis Choice' to the patient. FINDINGS The following were the four main findings: the decision was experienced as being the patient's own; the meetings contributed to the decision process; 'Dialysis Choice' contributed to the decision process; and the decision process was experienced as being iterative. CONCLUSIONS The patients experienced SDM-DC as involving them in their choice of dialysis modality. Due to the iterative properties of the decision-making process, a shared decision-making intervention for dialysis choice has to be adapted to the needs of individual patients. The active mechanisms of the meetings with the dialysis coordinator were (1) questions to and from the patient, and (2) the dialysis coordinator providing accurate information about the options. The overview of options and the value clarification tool in the decision aid were particularly helpful in establishing a decision-making process based on informed preferences.
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Affiliation(s)
- Jeanette Finderup
- Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jens Dam Jensen
- Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Clinical Medicine, Aarhus University, Aarhus N, Denmark
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