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Poinen K, Mitra S, Quinn RR. The integrated care model: facilitating initiation of or transition to home dialysis. Clin Kidney J 2024; 17:i13-i20. [PMID: 38846413 PMCID: PMC11151114 DOI: 10.1093/ckj/sfae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Indexed: 06/09/2024] Open
Abstract
A proportion of end-stage kidney disease (ESKD) patients require kidney replacement therapy to maintain clinical stability. Home dialysis therapies offer convenience, autonomy and potential quality of life improvements, all of which were heightened during the COVID-19 pandemic. While the superiority of specific modalities remains uncertain, patient choice and informed decision-making remain crucial. Missed opportunities for home therapies arise from systemic, programmatic and patient-level barriers. This paper introduces the integrated care model which prioritizes the safe and effective uptake of home therapies while also emphasizing patient-centered care, informed decision-making, and comprehensive support. The integrated care framework addresses challenges in patient identification, assessment, eligibility determination, education and modality transitions. Special considerations for urgent dialysis starts are discussed, acknowledging the unique barriers faced by this population. Continuous quality improvement is emphasized, with the understanding that local challenges may require tailored solutions. Overall, the integrated care model aims to create a seamless and beneficial transition to home dialysis therapies, promoting flexibility and improved quality of life for ESKD patients globally.
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Affiliation(s)
- Krishna Poinen
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Sandip Mitra
- Department of Renal Medicine, Manchester Academy of Health Sciences Centre Manchester University Hospitals, University of Manchester, Manchester, UK
| | - Robert R Quinn
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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2
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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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3
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Gazaway S, Gutierrez O, Wells R, Nix‐Parker T, Lyas C, Daniel S, Lang‐Lindsey K, Bryant T, Knight R, Odom JN. Exploring the health-related decision-making experiences of people with chronic kidney disease and their caregivers: A qualitative study. Health Expect 2023; 27:e13907. [PMID: 37926914 PMCID: PMC10757106 DOI: 10.1111/hex.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the decision-making experience of patients with chronic kidney disease (CKD) and their caregivers. METHODS This was a qualitative descriptive study of the decision-making experiences of individuals with stage 3-end-stage CKD and their family caregivers. One-on-one, semistructured interviews were conducted using a guide developed and approved by a community advisory group. Data were analyzed using thematic analysis. RESULTS Three themes were identified: (1) decisions triggered by declining health and broad in scope, (2) challenges to decision-making and (3) factors influencing decision-making. Participants' experiences with health-related decision-making demonstrated that decisions were triggered when health declined. Yet, decisions that impact disease progression were being made in stage 3. Decision-making was made difficult due to lack of information, complex co-morbidities, and poor resource utilization. However, the structure and nature of the medical appointment, supportive caregivers, and resources served to remove challenges. CONCLUSION Decision-support interventions must train patients and caregivers to be empowered participants in answer-seeking behaviours upstream of advanced illness. PUBLIC CONTRIBUTIONS This work was conducted in full collaboration with a community advisory board consisting of patients with CKD, caregivers and clinicians. These members are noted in the acknowledgement section, and those who worked with the team to develop the interview guide, study protocols, and manuscript preparation are included as authors. As part of their role, advisory members met monthly, providing input on recruitment, study progress, inclusion of diverse voices and added relevance to study findings.
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Affiliation(s)
- Shena Gazaway
- Division Family, Commuity, & Health Systems, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Orlando Gutierrez
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rachel Wells
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tamara Nix‐Parker
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Claretha Lyas
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Shawona Daniel
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Katina Lang‐Lindsey
- Department of Social Work, Psychology and CounselingAlabama A&M UniversityHuntsvilleAlabamaUSA
| | | | | | - James N. Odom
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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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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Law M, Weiner DE, Ladin K. Designing Clinical Trials for Shared Decision-Making Interventions in Nephrology. Am J Kidney Dis 2023:S0272-6386(23)00651-0. [PMID: 37318401 DOI: 10.1053/j.ajkd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Makenna Law
- Research on Ethics, Aging, and Community Health (REACH) Lab, Tufts University, Medford, Massachusetts
| | - Daniel E Weiner
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Keren Ladin
- Research on Ethics, Aging, and Community Health (REACH) Lab, Tufts University, Medford, Massachusetts; Department of Community Health, Tufts University, Medford, Massachusetts.
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Perl J, Brown EA, Chan CT, Couchoud C, Davies SJ, Kazancioğlu R, Klarenbach S, Liew A, Weiner DE, Cheung M, Jadoul M, Winkelmayer WC, Wilkie ME. Home dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2023; 103:842-858. [PMID: 36731611 DOI: 10.1016/j.kint.2023.01.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/09/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Abstract
Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding use of home dialysis within a given health system requires alignment of policy, fiscal resources, organizational structure, provider incentives, and accountability. Clinical outcomes across all dialysis modalities are largely similar, but for specific clinical measures, one modality may have advantages over another. Therefore, choice among available modalities is preference-sensitive, with consideration of quality of life, life goals, clinical characteristics, family or care-partner support, and living environment. Ideally, individuals, their care-partners, and their healthcare teams will employ shared decision-making in assessing initial and subsequent kidney failure treatment options. To meet this goal, iterative, high-quality education and support for healthcare professionals, patients, and care-partners are priorities. Everyone who faces dialysis should have access to home therapy. Facilitating universal access to home dialysis and expanding utilization requires alignment of policy considerations and resources at the dialysis-center level, with clear leadership from informed and motivated clinical teams.
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Affiliation(s)
- Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Christopher T Chan
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Simon J Davies
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | - Rümeyza Kazancioğlu
- Department of Nephrology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Daniel E Weiner
- William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Michel Jadoul
- Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Martin E Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
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7
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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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8
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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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Engels N, van der Nat PB, Ankersmid JW, Prick JCM, Parent E, The R, Takahashi A, Bart HAJ, van Uden-Kraan CF, Stiggelbout AM, Bos WJW, van den Dorpel MA. Development of an online patient decision aid for kidney failure treatment modality decisions. BMC Nephrol 2022; 23:236. [PMID: 35794539 PMCID: PMC9257566 DOI: 10.1186/s12882-022-02853-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patient decision aids (PtDAs) support patients and clinicians in shared decision-making (SDM). Real-world outcome information may improve patients’ risk perception, and help patients make decisions congruent with their expectations and values. Our aim was to develop an online PtDA to support kidney failure treatment modality decision-making, that: 1) provides patients with real-world outcome information, and 2) facilitates SDM in clinical practice.
Methods
The International Patient Decision Aids Standards (IPDAS) development process model was complemented with a user-centred and convergent mixed-methods approach. Rapid prototyping was used to develop the PtDA with a multidisciplinary steering group in an iterative process of co-creation. The results of an exploratory evidence review and a needs-assessment among patients, caregivers, and clinicians were used to develop the PtDA. Seven Dutch teaching hospitals and two national Dutch outcome registries provided real-world data on selected outcomes for all kidney failure treatment modalities. Alpha and beta testing were performed to assess the prototype and finalise development. An implementation strategy was developed to guide implementation of the PtDA in clinical practice.
Results
The ‘Kidney Failure Decision Aid’ consists of three components designed to help patients and clinicians engage in SDM: 1) a paper hand-out sheet, 2) an interactive website, and 3) a personal summary sheet. A ‘patients-like-me’ infographic was developed to visualise survival probabilities for each treatment modality on the website. Other treatment outcomes were incorporated as event rates (e.g. hospitalisation rates) or explained in text (e.g. the flexibility of each treatment modality). No major revisions were needed after alpha and beta testing. During beta testing, some patients ignored the survival probabilities because they considered these too confronting. Nonetheless, patients agreed that every patient has the right to choose whether they want to view this information. Patients and clinicians believed that the PtDA would help patients make informed decisions, and that it would support values- and preferences-based decision-making. Implementation of the PtDA has started in October 2020.
Conclusions
The ‘Kidney Failure Decision Aid’ was designed to facilitate SDM in clinical practice and contains real-world outcome information on all kidney failure treatment modalities. It is currently being investigated for its effects on SDM in a clinical trial.
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Jones GL, Moss RH, Darby F, Mahmoodi N, Phillips B, Hughes J, Vogt KS, Greenfield DM, Brauten-Smith G, Gath J, Campbell T, Stark D, Velikova G, Snowden JA, Baskind E, Mascerenhas M, Yeomanson D, Skull J, Lane S, Bekker HL, Anderson RA. Cancer, Fertility and Me: Developing and Testing a Novel Fertility Preservation Patient Decision Aid to Support Women at Risk of Losing Their Fertility Because of Cancer Treatment. Front Oncol 2022; 12:896939. [PMID: 35847858 PMCID: PMC9280471 DOI: 10.3389/fonc.2022.896939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Women with a new cancer diagnosis face complex decisions about interventions aiming to preserve their fertility. Decision aids are more effective in supporting decision making than traditional information provision. We describe the development and field testing of a novel patient decision aid designed to support women to make fertility preservation treatment decisions around cancer diagnosis. Methods A prospective, mixed-method, three stage study involving: 1) co-development of the resource in collaboration with a multi-disciplinary group of key stakeholders including oncology and fertility healthcare professionals and patient partners (n=24), 2) alpha testing with a group of cancer patients who had faced a fertility preservation treatment decision in the past (n=11), and oncology and fertility healthcare professionals and stakeholders (n=14) and, 3) beta testing with women in routine care who had received a recent diagnosis of cancer and were facing a fertility preservation treatment decision (n=41) and their oncology and fertility healthcare professionals (n=3). Ten service users recruited from a closed Breast Cancer Now Facebook group and the support group Cancer and Fertility UK also provided feedback on CFM via an online survey. Results A 60-page paper prototype of the Cancer, Fertility and Me patient decision aid was initially developed. Alpha testing of the resource found that overall, it was acceptable to cancer patients, healthcare professionals and key stakeholders and it was considered a useful resource to support fertility preservation treatment decision-making. However, the healthcare professionals felt that the length of the patient decision aid, and elements of its content may be a barrier to its use. Subsequently, the prototype was reduced to 40 pages. During beta testing of the shortened version in routine care, women who received the resource described its positive impact on their ability to make fertility preservation decisions and support them at a stressful time. However, practical difficulties emerged which impacted upon its wider dissemination in clinical practice and limited some elements of the evaluation planned. Discussion Women receiving the decision aid within the cancer treatment pathway found it helped them engage with decisions about fertility preservation, and make better informed, values-based care plans with oncology and fertility teams. More work is needed to address access and implementation of this resource as part of routine oncology care pathways.
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Affiliation(s)
- Georgina L. Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Rachael H. Moss
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Frances Darby
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Neda Mahmoodi
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Bob Phillips
- Hull-York Medical School and Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Jane Hughes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Katharina S. Vogt
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Diana M. Greenfield
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | | | - Jacqui Gath
- Independent Cancer Patients’ Voice, London, United Kingdom
| | | | - Daniel Stark
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute for Medical Research, University of Leeds, Leeds, United Kingdom
| | - John A. Snowden
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Ellissa Baskind
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Daniel Yeomanson
- Haematology and Oncology, Sheffield Children’s Hospital, Sheffield, United Kingdom
| | - Jonathan Skull
- Department of Oncology and Metabolism, University of Sheffield and Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Sheila Lane
- Department of Paediatric Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Hilary L. Bekker
- Leeds Unit of Complex Intervention Development (LUCID), School of Medicine, University of Leeds, Leeds, United Kingdom
- Research Centre for Patient Involvement (ResCenPI) Central Region Denmark, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
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Buur LE, Finderup J, Søndergaard H, Kannegaard M, Madsen JK, Bekker HL. Mapping the empirical evidence on patient involvement interventions in patients with end-stage kidney disease making end-of-life care decisions: a scoping review protocol. JBI Evid Synth 2022; 20:1537-1544. [PMID: 34930870 DOI: 10.11124/jbies-21-00090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review is to investigate and map existing empirical evidence on patient involvement interventions helping patients with end-stage kidney disease to make end-of-life care decisions about kidney services. INTRODUCTION Patients with end-stage kidney disease have a high disease burden and mortality rate. Despite this, kidney services differ in how they offer and integrate end-of-life care, if it is offered at all. Some countries have established advance care planning protocols to encourage patient involvement when offering end-of-life care options as part of end-stage kidney disease care. However, there is a limited understanding of the components of patient involvement interventions designed to support patients with end-stage kidney disease making decisions about end-of-life care. INCLUSION CRITERIA The review will consider studies on patient involvement interventions concerning end-of-life care decisions for patients with end-stage kidney disease. A broad definition of patient involvement interventions will be used. Studies on interventions that do not involve patients or relatives will be excluded. The review will focus on interventions applied to kidney health care and other services, such as community-based health care. METHODS MEDLINE, Embase, Scopus, and CINAHL will be searched. The literature will be screened for inclusion by two independent reviewers. Data synthesis will be conducted through relational analysis investigating patient involvement interventions and relevant information in line with the review objective and questions. Data will be extracted and listed in the data extraction instruments, accompanied by a narrative summary describing how the results relate to the review objective.
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Affiliation(s)
- Louise Engelbrecht Buur
- Department of Renal Medicine, Aarhus University Hospital, Denmark
- ResCenPI - Research Centre for Patient Involvement, Aarhus University and Central Denmark Region, Denmark
- Department of Public Health, Aarhus University, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Denmark
- ResCenPI - Research Centre for Patient Involvement, Aarhus University and Central Denmark Region, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | | | | | | | - Hilary Louise Bekker
- ResCenPI - Research Centre for Patient Involvement, Aarhus University and Central Denmark Region, Denmark
- Department of Public Health, Aarhus University, Denmark
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Science, University of Leeds, UK
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12
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Eneanya ND, Lakin JR, Paasche-Orlow MK, Lindvall C, Moseley ET, Henault L, Hanchate AD, Mandel EI, Wong SPY, Zupanc SN, Davis AD, El-Jawahri A, Quintiliani LM, Chang Y, Waikar SS, Bansal AD, Schell JO, Lundquist AL, Tamura MK, Yu MK, Unruh ML, Argyropoulos C, Germain MJ, Volandes A. Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial. BMJ Open 2022; 12:e059313. [PMID: 35396311 PMCID: PMC8996022 DOI: 10.1136/bmjopen-2021-059313] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/11/2022] Open
Abstract
INTRODUCTION Older patients with advanced chronic kidney disease (CKD) often are inadequately prepared to make informed decisions about treatments including dialysis and cardiopulmonary resuscitation. Further, evidence shows that patients with advanced CKD do not commonly engage in advance care planning (ACP), may suffer from poor quality of life, and may be exposed to end-of-life care that is not concordant with their goals. We aim to study the effectiveness of a video intervention on ACP, treatment preferences and other patient-reported outcomes. METHODS AND ANALYSIS The Video Images about Decisions for Ethical Outcomes in Kidney Disease trial is a multi-centre randomised controlled trial that will test the effectiveness of an intervention that includes a CKD-related video decision aid followed by recording personal video declarations about goals of care and treatment preferences in older adults with advancing CKD. We aim to enrol 600 patients over 5 years at 10 sites. ETHICS AND DISSEMINATION Regulatory and ethical aspects of this trial include a single Institutional Review Board mechanism for approval, data use agreements among sites, and a Data Safety and Monitoring Board. We intend to disseminate findings at national meetings and publish our results. TRIAL REGISTRATION NUMBER NCT04347629.
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua R Lakin
- Harvard Medical School, Boston, Massachusetts, USA
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael K Paasche-Orlow
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Charlotta Lindvall
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Edward T Moseley
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lori Henault
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Amresh D Hanchate
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ernest I Mandel
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Renal (Kidney) Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Susan P Y Wong
- University of Washington, Seattle, Washington State, USA
| | - Sophia N Zupanc
- Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Areej El-Jawahri
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa M Quintiliani
- Boston University School of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Yuchiao Chang
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Amar D Bansal
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Andrew L Lundquist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine; and Geriatric Research Education Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Margaret K Yu
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mark L Unruh
- Department of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christos Argyropoulos
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Michael J Germain
- Baystate Medical Center-University of Massachusetts Springfield, Springfield, Massachusetts, USA
| | - Angelo Volandes
- Harvard Medical School, Boston, Massachusetts, USA
- ACP Decisions Non-profit Foundation, Newton, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Ladin K, Frazier RS. The Elusive Promise of Shared Decision Making: A Step Forward. Am J Kidney Dis 2022; 79:623-625. [DOI: 10.1053/j.ajkd.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/11/2022]
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14
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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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15
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Ozdemir S, Choong LHL, Gan SWS, Lim LW, Malhotra C, Jafar TH, Yee ACP, Vishwanath P, Tan SNG, Finkelstein EA. Patient Decision Aid Development for Older Adults With End-Stage Kidney Disease in Singapore. Kidney Int Rep 2021; 6:2885-2896. [PMID: 34805639 PMCID: PMC8589693 DOI: 10.1016/j.ekir.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 10/25/2022] Open
Abstract
Introduction In managing end-stage kidney disease (ESKD), older adults face a decision regarding whether to undergo dialysis or manage symptoms through kidney supportive care (KSC). This article describes the development of a patient decision aid (PDA) that is designed specifically for older adults with ESKD. Methods The decision context of the PDA was to choose a treatment between hemodialysis, peritoneal dialysis, and KSC. The development process used insights obtained from qualitative interviews with patients, informal caregivers, and health care providers. The PDA was then developed in English and Mandarin and was pilot-tested with patients, caregivers, and health care providers. We finalized the PDA based on feedback from pilot testing and performed a preliminary evaluation based on the International Patient Decision Aid Standards (IPDASi v4.0) criteria. Results The final PDA consists of 2 booklets and a video. During pilot testing, patients and caregivers reported high levels of ease of understanding and usefulness with ≥92.5% providing agree/strongly agree responses for the "Content"-related criteria, and ≥75% providing agree/strongly agree responses for the "Development Process and Effectiveness"-related criteria. The final PDA met 10 of 12 IPDASi v4.0 criteria. Conclusions This PDA was found useful during pilot-testing. It will be used during renal counseling in Singapore to help older adults with ESKD and their caregivers make informed decisions on which treatment option is best for the patients.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Lydia Wei Lim
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Tazeen H Jafar
- Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | | | | | - Eric Andrew Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore.,Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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16
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Saeed F, Shah AY, Allen RJ, Epstein RM, Fiscella KA. Communication principles and practices for making shared decisions about renal replacement therapy: a review of the literature. Curr Opin Nephrol Hypertens 2021; 30:507-515. [PMID: 34148978 PMCID: PMC8373782 DOI: 10.1097/mnh.0000000000000731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the skill set required for communication and person-centered decision making for renal replacement therapy (RRT) choices, especially conservative kidney management (CKM). RECENT FINDINGS Research on communication and decision-making skills for shared RRT decision making is still in infancy. We adapt literature from other fields such as primary care and oncology for effective RRT decision making. SUMMARY We review seven key skills: (1) Announcing the need for decision making (2) Agenda Setting (3) Educating patients about RRT options (4) Discussing prognoses (5) Eliciting patient preferences (6) Responding to emotions and showing empathy, and (7) Investing in the end. We also provide example sentences to frame the conversations around RRT choices including CKM.
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Affiliation(s)
- Fahad Saeed
- Departments of Medicine and Public Health, Division of Nephrology
- Division of Palliative Care
- University of Rochester School of Medicine, National University of Medical Sciences
| | - Amna Yousaf Shah
- Rawalpindi, Pakistan; CITE Center, Department of Behavioral and Natural Sciences
| | | | - Ronald M Epstein
- Division of Palliative Care
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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17
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Shi Y, Li W, Duan F, Pu S, Peng H, Ha M, Luo Y. Factors promoting shared decision-making in renal replacement therapy for patients with end-stage kidney disease: systematic review and qualitative meta-synthesis. Int Urol Nephrol 2021; 54:553-574. [PMID: 34159522 PMCID: PMC8831292 DOI: 10.1007/s11255-021-02913-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/06/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE Shared decision-making (SDM) about the type of renal replacement therapy to use is a matter of great importance involving patients, their families, and health treatment teams. This review aims to synthesize the volume of qualitative work explaining the factors influencing SDM regarding renal replacement therapy. METHODS A systematic review and qualitative meta-synthesis approach recommended by JBI was used, six databases were searched. Studies were qualitative or mixed research published since 2000, with a primary focus on patient experiences, perceptions and practices regarding which method to choose for renal replacement therapy in End-Stage Kidney Disease (ESKD) patients. All themes were analyzed and compared to the established connectedness. RESULTS A total of 1313 patients were enrolled in 32 studies focusing on factors associated with SDM regarding renal replacement therapy were included. All quality evaluations of the literature were medium to high. Four common themes were identified in our synthesis: (1) patient personal reasons, (2) family-related factors, (3) health care professional-related factors, and (4) social factors influence. CONCLUSION The model proposes pathways that could be explored further in future qualitative and quantitative studies and suggests that patients' beliefs, emotions, and awareness should be targeted alongside patients' decision-making practices to increase the efficacy of interventions. The majority of studies included in this review focus on older patients, and all report patients' perspectives. Further research is required to understand the family member perspectives on SMD of renal replacement therapy.
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Affiliation(s)
- Yu Shi
- School of Nursing, Third Military Medical University (Army Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China.,Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Wang Li
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Fangjian Duan
- School of Nursing, Third Military Medical University (Army Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Shi Pu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Hongmei Peng
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Mei Ha
- School of Nursing, Third Military Medical University (Army Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Yu Luo
- School of Nursing, Third Military Medical University (Army Medical University), No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400038, People's Republic of China.
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18
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Witteman HO, Maki KG, Vaisson G, Finderup J, Lewis KB, Dahl Steffensen K, Beaudoin C, Comeau S, Volk RJ. Systematic Development of Patient Decision Aids: An Update from the IPDAS Collaboration. Med Decis Making 2021; 41:736-754. [PMID: 34148384 DOI: 10.1177/0272989x211014163] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The 2013 update of the evidence informing the quality dimensions behind the International Patient Decision Aid Standards (IPDAS) offered a model process for developers of patient decision aids. OBJECTIVE To summarize and update the evidence used to inform the systematic development of patient decision aids from the IPDAS Collaboration. METHODS To provide further details about design and development methods, we summarized findings from a subgroup (n = 283 patient decision aid projects) in a recent systematic review of user involvement by Vaisson et al. Using a new measure of user-centeredness (UCD-11), we then rated the degree of user-centeredness reported in 66 articles describing patient decision aid development and citing the 2013 IPDAS update on systematic development. We contacted the 66 articles' authors to request their self-reports of UCD-11 items. RESULTS The 283 development processes varied substantially from minimal iteration cycles to more complex processes, with multiple iterations, needs assessments, and extensive involvement of end users. We summarized minimal, medium, and maximal processes from the data. Authors of 54 of 66 articles (82%) provided self-reported UCD-11 ratings. Self-reported scores were significantly higher than reviewer ratings (reviewers: mean [SD] = 6.45 [3.10]; authors: mean [SD] = 9.62 [1.16], P < 0.001). CONCLUSIONS Decision aid developers have embraced principles of user-centered design in the development of patient decision aids while also underreporting aspects of user involvement in publications about their tools. Templates may reduce the need for extensive development, and new approaches for rapid development of aids have been proposed when a more detailed approach is not feasible. We provide empirically derived benchmark processes and a reporting checklist to support developers in more fully describing their development processes.[Box: see text].
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Canada.,VITAM Research Centre, Quebec City, Canada.,CHU de Québec Research Centre, Quebec City, Canada
| | - Kristin G Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Jeanette Finderup
- Research Centre for Patient Involvement & Department of Renal Medicine, Aarhus University & Aarhus University Hospital, Aarhus, Denmark
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making/Department of Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, Vejle, Denmark
| | - Caroline Beaudoin
- Department of Family and Emergency Medicine, Laval University, Quebec, Canada
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Laval University, Quebec, Canada
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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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20
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Stallings TL, Temel JS, Klaiman TA, Paasche-Orlow MK, Alegria M, O'Hare A, O'Connor N, Dember LM, Halpern SD, Eneanya ND. Integrating Conservative kidney management Options and advance care Planning Education (COPE) into routine CKD care: a protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e042620. [PMID: 33619188 PMCID: PMC7903110 DOI: 10.1136/bmjopen-2020-042620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Predialysis education for patients with advanced chronic kidney disease (CKD) typically focuses narrowly on haemodialysis and peritoneal dialysis as future treatment options. However, patients who are older or seriously ill may not want to pursue dialysis and/or may not benefit from this treatment. Conservative kidney management, a reasonable alternative treatment, and advance care planning (ACP) are often left out of patient education and shared decision-making. In this study, we will pilot an educational intervention (Conservative Kidney Management Options and Advance Care Planning Education-COPE) to improve knowledge of conservative kidney management and ACP among patients with advanced CKD who are older and/or have poor functional status. METHODS AND ANALYSIS This is a single-centre pilot randomised controlled trial at an academic centre in Philadelphia, PA. Eligible patients will have: age ≥70 years and/or poor functional status (as defined by Karnofsky Performance Index Score <70), advanced CKD (estimated glomerular filtration rate<20 mL/min/1.73 m2), prefer to speak English during clinical encounters and self-report as black or white race. Enrolled patients will be randomised 1:1, with stratification by race, to receive enhanced usual care or usual care and in-person education about conservative kidney management and ACP (COPE). The primary outcome is change in knowledge of CKM and ACP. We will also explore intervention feasibility and acceptability, change in communication of preferences and differences in the intervention's effects on knowledge and communication of preferences by race. We will assess outcomes at baseline, immediately post-education and at 2 and 12 weeks. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board at the University of Pennsylvania. We will obtain written informed consent from all participants. The results from this work will be presented at academic conferences and disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER This trial is registered at ClinicalTrials.gov under NCT03229811.
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Affiliation(s)
- Taylor L Stallings
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer S Temel
- Division of Hematology and Oncology, Department of Internal Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Tamar A Klaiman
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Margarita Alegria
- Department of Medicine and Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ann O'Hare
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Nina O'Connor
- Palliative and Hospice Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura M Dember
- Renal-Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott D Halpern
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nwamaka D Eneanya
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Renal-Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Parapiboon W, Pitsawong W, Wongluechai L, Thammavaranucupt K, Raegasint L. Customized versus conventional video counseling for peritoneal dialysis decision-making in patients with stage 5 chronic kidney disease under a PD-first policy: a randomized controlled study. Kidney Res Clin Pract 2020; 39:451-459. [PMID: 33184239 PMCID: PMC7770997 DOI: 10.23876/j.krcp.20.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background Indecision regarding the start of peritoneal dialysis (PD) is a challenging problem in chronic kidney disease (CKD) stage 5 patients who receive conventional video counseling. This study aimed to evaluate the effect of video counseling customized to the local context versus conventional video counseling on PD decision-making in CKD stage 5 patients under PD-first policy. Methods We enrolled 120 patients with stage 5 CKD in Thailand who initiate PD between May 2016 to January 2017 in a randomized, open-label, controlled study. Patients were randomized to either a customized or conventional video counseling group. The primary outcome was PD acceptance rate with complete PD catheter insertion on schedule. The secondary outcomes were change in patient knowledge and confidence in PD and reasons for indecision PD. Results We analyzed 120 patients (customized, n = 60 vs. conventional, n = 60). The two groups were similar for age (55 vs. 56 years), blood urea nitrogen (89 vs. 86 mg/dL), creatinine (10.37 vs. 11.29 mg/dL), and eGFR (4.7 vs. 5.6 mL/min/1.73 m2). The PD acceptance rate along with PD catheter insertion on schedule in the customized video counseling group was not significantly different from that in the conventional video counseling group (66.6% vs. 63.3%, relative risk 0.97, 95% confidence interval 0.73 to 1.29; P = 0.86). Patient knowledge of and confidence in PD increased after counseling, but the difference was not significant. Conclusion Among stage 5 CKD patients, counseling content customized to a local context did not differ in a rate of acceptance for beginning PD with PD catheter insertion on schedule compared with conventional video counseling.
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Affiliation(s)
- Watanyu Parapiboon
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Wannapat Pitsawong
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Laddaporn Wongluechai
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | - Lalana Raegasint
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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22
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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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23
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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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24
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Oestreich T, Sayre G, O'Hare AM, Curtis JR, Wong SPY. Perspectives on Conservative Care in Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members. Am J Kidney Dis 2020; 77:355-364.e1. [PMID: 33010356 PMCID: PMC8148987 DOI: 10.1053/j.ajkd.2020.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/25/2020] [Indexed: 11/15/2022]
Abstract
Rationale & Objective: Little is known about perceptions of conservative care among patients with advanced kidney disease in the United States. Study Design: Qualitative study using cognitive interviewing about attitudes regarding conservative care using decision aids on treatments for advanced kidney disease developed outside the United States. Setting & Participants: 14 patients 75 years or older with advanced kidney disease, defined as estimated glomerular filtration rate ≤ 20 mL/min/1.73 m2 and not receiving maintenance dialysis, and 6 of their family members. Analytical Approach: Thematic analysis of participants’ reactions to descriptions of conservative care taken from various clinical care decision aids. Results: Participants were mostly White (n = 15) and had at least some college education (n = 16). Four themes emerged from analysis of interviews: (1) core elements of conservative care: aspects of conservative care that were appealing to participants included a whole-person, team-based, and structured approach to care that focused on symptom management, maintaining current lifestyle, and managing health setbacks; (2) importance of how conservative care is framed: participants were more receptive to conservative care when this was framed as an active rather than passive treatment approach and were receptive to statements of uncertainty about future course of illness and prognosis; (3) an explicit approach to shared decision making: participants believed decisions about conservative care and dialysis should address considerations about risk and benefits of treatment options, family and clinician perspectives, and patients’ goals, values, and preferences; and (4) relationship between conservative care and dialysis: although conservative care models outside the United States are generally intended to serve as an alternative to dialysis, participants’ comments implied that they did not see conservative care and dialysis as mutually exclusive. Limitations: Themes identified may not generalize to the broader population of US patients with advanced kidney disease and their family members. Conclusions: Participants were favorably disposed to a whole-person multidisciplinary approach to conservative care, especially when framed as an active treatment approach. Models of conservative care excluding the possibility of dialysis were less embraced, suggesting that current models will require adaptation to meet the needs of US patients and their families. Conservative care is an important therapeutic option for patients with advanced kidney disease who believe that the burdens of dialysis are not outweighed by its potential benefits. However, efforts in this country to develop conservative options for patients who wish to pursue dialysis have lagged considerably behind those in other countries. In this study, we interviewed older patients with advanced kidney disease but not receiving maintenance dialysis and their family members about their reactions to descriptions of conservative care taken from decision aids developed in other countries. The findings suggest how models of conservative care developed in other countries could be adapted to meet the needs and preferences of US patients and their family members.
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Affiliation(s)
- Taryn Oestreich
- University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA
| | - George Sayre
- University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA
| | - Ann M O'Hare
- University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA
| | - J Randall Curtis
- University of Washington, Seattle, WA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
| | - Susan P Y Wong
- University of Washington, Seattle, WA; Health Services Research and Development Center, VA Puget Sound Health Care System, Seattle, WA.
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25
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Inkeroinen S, Virtanen H, Kilpi T, Laulaja J, Puukka P, Tuominen R, Leino-Kilpi H. Relationship between sufficiency and usefulness of patient education: A cross-sectional study of patients with chronic kidney disease. Nurs Health Sci 2020; 22:846-853. [PMID: 32840003 DOI: 10.1111/nhs.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/12/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
The aim of this descriptive study was to analyze the relationship between the sufficiency and usefulness of patient education from the perspective of people with chronic kidney disease. The goal was to discover whether both sufficiency and usefulness need to be analyzed in the quality evaluation of patient education. Patients undergoing predialysis or home dialysis care in Finland (N = 162) evaluated both the sufficiency and usefulness of patient education provided by nephrology nurses by using parallel structured questionnaires. A strong relationship was found between the sufficiency and usefulness of patient education. The relationship was significant across all dimensions of empowering knowledge, but no systematic association was found between the sufficiency-usefulness relationship and background variables. Depending on the purpose of evaluating patient education, either aspect, that is, sufficiency or usefulness, can be used, but it is not necessary to use both due to their strong inter-correlation. In terms of implications for practice, consideration of both sufficiency and usefulness is important when providing empowering patient education for people undergoing pre- or home dialysis, but only one aspect needs to be evaluated.
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Affiliation(s)
- Saija Inkeroinen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Heli Virtanen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Taina Kilpi
- Turku City Welfare, City of Turku, Turku, Finland
| | - Johanna Laulaja
- Kidney Center, Department of Medicine, Turku University Hospital, Turku, Finland
| | - Pauli Puukka
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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26
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Eneanya ND, Percy SG, Stallings TL, Wang W, Steele DJR, Germain MJ, Schell JO, Paasche-Orlow MK, Volandes AE. Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial. Am J Nephrol 2020; 51:736-744. [PMID: 32791499 DOI: 10.1159/000509711] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/24/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND There are few studies of patient-facing decision aids that include supportive kidney care as an option. We tested the efficacy of a video decision aid on knowledge of supportive kidney care among older patients with advanced CKD. METHODS Participants (age ≥ 65 years with advanced CKD) were randomized to receive verbal or video education. Primary outcome was knowledge of supportive kidney care (score range 0-3). Secondary outcomes included preference for supportive kidney care, and satisfaction and acceptability of the video. RESULTS Among all participants (n = 100), knowledge of supportive kidney care increased significantly after receiving education (p < 0.01); however, there was no difference between study arms (p = 0.68). There was no difference in preference for supportive kidney care between study arms (p = 0.49). In adjusted analyses, total health literacy score (aOR 1.08 [95% CI: 1.003-1.165]) and nephrologists' answer of "No" to the Surprise Question (aOR 4.87 [95% CI: 1.22-19.43]) were associated with preference for supportive kidney care. Most felt comfortable watching the video (96%), felt the content was helpful (96%), and would recommend the video to others (96%). CONCLUSIONS Among older patients with advanced CKD, we did not detect a significant difference between an educational verbal script and a video decision aid in improving knowledge of supportive kidney care or preferences. However, patients who received video education reported high satisfaction and acceptability ratings. Future research will determine the effectiveness of a supportive kidney care video decision aid on real-world patient outcomes. TRIAL REGISTRATION NCT02698722 (ClinicalTrials.gov).
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Shananssa G Percy
- Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School Center, Boston, Massachusetts, USA
| | - Taylor L Stallings
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Wang
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J R Steele
- Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School Center, Boston, Massachusetts, USA
| | - Michael J Germain
- Division of Nephrology, Baystate Medical Center, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA
| | - Jane O Schell
- Division of Renal-Electrolyte, Department of General Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Angelo E Volandes
- Division of General Medicine, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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27
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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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28
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Winterbottom AE, Mooney A, Russon L, Hipkiss V, Williams R, Ziegler L, Bekker HL. Critical review of leaflets about conservative management used in uk renal services. J Ren Care 2020; 46:250-257. [PMID: 32270601 DOI: 10.1111/jorc.12327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Written information supplements nurse-led education about treatment options. It is unclear if this information enhances patients' reasoning about conservative management (CM) and renal replacement therapy decisions. AIM This study describes a critical review of resources U.K. renal staff use when providing CM options to people with Established Kidney Disease (EKD) during usual pre-dialysis education. DESIGN A survey using mixed methods identified and critically analysed leaflets about CM. PARTICIPANTS & MEASUREMENTS All 72 renal units in the United Kingdom received an 11-item questionnaire to elicit how CM education is delivered, satisfaction and/or needs with patient resources and staff training. Copies of leaflets were requested. A coding frame was utilised to produce a quality score for each leaflet. RESULTS Fifty-four (75%) units participated. Patients discuss CM with a nephrologist (98%) or nurse (100%). Eighteen leaflets were reviewed, mean scores were 8.44 out of 12 (range 5-12, SD = 2.49) for information presentation; 3.50 out of 6 (range 0-6, SD = 1.58) for inclusion of information known to support shared decision-making and 2.28 out of 6 (range 1-4, SD = 0.96) for presenting non-biased information. CONCLUSIONS Nurses preferred communicating via face-to-face contact with patients and/or families because of the emotional consequences and complexity of planning treatment for the next stage of a person's worsening kidney disease. Conversations were supplemented with written information; 66% of which were produced locally. Staff perceived a need for using leaflets, and spend time and resources developing them to support their services. However, no leaflets included the components needed to help people reason about conservative care and renal replacement therapy options during EKD education consultations.
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Affiliation(s)
- Anna E Winterbottom
- Adult Renal Services, Lincoln Wing, St. James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Andrew Mooney
- Adult Renal Services, Lincoln Wing, St. James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Lynne Russon
- Sue Ryder Care, Wheatfields Hospice, Grove Road, Headingley, Leeds, LS6 2AE, UK
| | - Vicki Hipkiss
- Bradford Renal Unit, Horton Wing, St. Luke's Hospital, 1st Floor, Little Horton Lane, West Yorkshire, BD5 0NA, UK
| | - Richard Williams
- Adult Renal Services, Lincoln Wing, St. James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Worsley Building-Level 10, Clarendon Way, Leeds, LS2 9NL, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Worsley Building-Level 10, Clarendon Way, Leeds, LS2 9NL, UK
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29
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Raj R, Brown B, Ahuja K, Frandsen M, Jose M. Enabling good outcomes in older adults on dialysis: a qualitative study. BMC Nephrol 2020; 21:28. [PMID: 31996167 PMCID: PMC6988330 DOI: 10.1186/s12882-020-1695-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background Older patients on dialysis may not have optimal outcomes, particularly with regards to quality of life. Existing research is focused mainly on survival, with limited information about other outcomes. Such information can help in shared decision-making around dialysis initiation; it can also be used to improve outcomes in patients established on dialysis. We used qualitative research methods to explore patient perspectives regarding their experience and outcomes with dialysis. Methods Semi-structured interviews with participants aged ≥70, receiving dialysis at a regional Australian hospital, were recorded and transcribed. From participants’ responses, we identified descriptive themes using a phenomenological approach, with verification by two researchers. Factors affecting outcomes were derived reflexively from these themes. Results Seventeen interviews were analysed prior to saturation of themes. Participants (12 on haemodialysis, 5 on peritoneal dialysis) had spent an average of 4.3 years on dialysis. There were 11 males and 6 females, with mean age 76.2 years (range 70 to 83). Experiences of dialysis were described across four domains - the self, the body, effects on daily life and the influences of others; yielding themes of (i) responses to loss (of time, autonomy, previous life), (ii) responses to uncertainty (variable symptoms; unpredictable future; dependence on others), (iii) acceptance / adaptation (to life on dialysis; to ageing) and (iv) the role of relationships / support (family, friends and clinicians). Conclusions Older patients experience the effects of dialysis across multiple domains in their lives. They endure feelings of loss and persistent uncertainty, but may also adapt successfully to their new circumstances, aided by the support they receive from family, health professionals and institutions. From these insights, we have suggested practical measures to improve outcomes in older patients.
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Affiliation(s)
- Rajesh Raj
- School of Medicine, University of Tasmania, Hobart, Australia. .,Launceston General Hospital, Launceston, Tasmania, 7250, Australia.
| | - Bridget Brown
- Launceston General Hospital, Launceston, Tasmania, 7250, Australia
| | - Kiran Ahuja
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Mai Frandsen
- Faculty of Health, University of Tasmania, Hobart, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Australia
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30
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Henselmans I, van Laarhoven HW, van Maarschalkerweerd P, de Haes HC, Dijkgraaf MG, Sommeijer DW, Ottevanger PB, Fiebrich H, Dohmen S, Creemers G, de Vos FY, Smets EM. Effect of a Skills Training for Oncologists and a Patient Communication Aid on Shared Decision Making About Palliative Systemic Treatment: A Randomized Clinical Trial. Oncologist 2019; 25:e578-e588. [PMID: 32162796 PMCID: PMC7066716 DOI: 10.1634/theoncologist.2019-0453] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. METHODS In this multicenter randomized controlled trial with four parallel arms (2016-2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio-recorded consultations. Secondary outcomes included patient-reported SDM, patient and oncologist satisfaction, patients' decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. RESULTS The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient-reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients' decisional conflict, quality of life, consultation duration, or the decision made. CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient-reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. TRIAL REGISTRATION Netherlands Trial Registry NTR 5489. IMPLICATIONS FOR PRACTICE Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient-reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists' practice and should be implemented in (continuing) educational programs.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Pomme van Maarschalkerweerd
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Hanneke C.J.M. de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Dirkje W. Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Department of Medical OncologyFlevoziekenhuis, AlmereThe Netherlands
| | | | | | - Serge Dohmen
- Department of Medical OncologyBovenIJZiekenhuis, AmsterdamThe Netherlands
| | - Geert‐Jan Creemers
- Department of Medical OncologyCatharinaziekenhuis, EindhovenThe Netherlands
| | - Filip Y.F.L. de Vos
- Department of Medical Oncology, University Medical Center UtrechtUtrechtThe Netherlands
| | - Ellen M.A. Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
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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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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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33
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Brown L, Gardner G, Bonner A. A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease. J Adv Nurs 2019; 75:3032-3044. [DOI: 10.1111/jan.14112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Leanne Brown
- School of Nursing and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Qld Australia
| | - Glenn Gardner
- School of Nursing and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Qld Australia
| | - Ann Bonner
- School of Nursing and Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Qld Australia
- Chronic Kidney Disease Centre for Research Excellence University of Queensland Brisbane Qld Australia
- Visiting Research Fellow, Kidney Health Service Metro North Hospital and Health Service Brisbane Qld Australia
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Henselmans I, Brugel SD, de Haes HCJM, Wolvetang KJA, de Vries LM, Pieterse AH, Baas-Thijssen MCM, de Vos FYF, van Laarhoven HWM, Smets EMA. Promoting shared decision making in advanced cancer: Development and piloting of a patient communication aid. PATIENT EDUCATION AND COUNSELING 2019; 102:916-923. [PMID: 30591283 DOI: 10.1016/j.pec.2018.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/16/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To learn how to configure a patient communication aid (PCA) to facilitate shared decision-making (SDM) about treatment for advanced cancer. METHODS The PCA consists of education about SDM, a question prompt list, and values clarification methods. Study 1. A first version was presented to 13 patients, 8 relatives and 14 bereaved relatives in interviews. Study 2. A second version was used by 18 patients in a pilot study. Patients and oncologists were interviewed, patients were surveyed, and consultations were audio-recorded. RESULTS Respondents reported that the aid facilitated patient control over information, raised choice awareness and promoted elaboration. Risks were identified, most importantly that the aid might upset patients. Also, some respondents reported that the PCA did not, or would not support decision making because they felt sufficiently competent, did not perceive a role for themselves, or did not perceive that the decision required elaboration. CONCLUSIONS Opinions on the usefulness of the PCA varied. It was challenging to raise awareness about the presence of a choice, and to find a balance between comprehensive information and sensitivity. PRACTICE IMPLICATIONS A future study should demonstrate whether the PCA can improve SDM, and whether this effect is stronger when oncologists receive training.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Sabrina D Brugel
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Kim J A Wolvetang
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Laura M de Vries
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Arwen H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, the Netherlands
| | | | - Filip Y F de Vos
- Department of Medical Oncology, University Medical Center Utrecht, the Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Medical Oncology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
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Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE, Mehrotra R, Stevens PE, Wang AYM, Cheung M, Wheeler DC, Winkelmayer WC, Pollock CA. Dialysis initiation, modality choice, access, and prescription: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 96:37-47. [PMID: 30987837 DOI: 10.1016/j.kint.2019.01.017] [Citation(s) in RCA: 203] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023]
Abstract
Globally, the number of patients undergoing maintenance dialysis is increasing, yet throughout the world there is significant variability in the practice of initiating dialysis. Factors such as availability of resources, reasons for starting dialysis, timing of dialysis initiation, patient education and preparedness, dialysis modality and access, as well as varied "country-specific" factors significantly affect patient experiences and outcomes. As the burden of end-stage kidney disease (ESKD) has increased globally, there has also been a growing recognition of the importance of patient involvement in determining the goals of care and decisions regarding treatment. In January 2018, KDIGO (Kidney Disease: Improving Global Outcomes) convened a Controversies Conference focused on dialysis initiation, including modality choice, access, and prescription. Here we present a summary of the conference discussions, including identified knowledge gaps, areas of controversy, and priorities for research. A major novel theme represented during the conference was the need to move away from a "one-size-fits-all" approach to dialysis and provide more individualized care that incorporates patient goals and preferences while still maintaining best practices for quality and safety. Identifying and including patient-centered goals that can be validated as quality indicators in the context of diverse health care systems to achieve equity of outcomes will require alignment of goals and incentives between patients, providers, regulators, and payers that will vary across health care jurisdictions.
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Affiliation(s)
| | - Peter J Blankestijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurizio Gallieni
- Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Charmaine E Lok
- University Health Network, University of Toronto, Ontario, Canada
| | - Rajnish Mehrotra
- Division of Nephrology, Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington, USA
| | - Paul E Stevens
- Kent Kidney Care Centre, East Kent Hospitals, University NHS Foundation Trust, Canterbury, Kent, UK
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Subramanian L, Zhao J, Zee J, Knaus M, Fagerlin A, Perry E, Swartz J, McCall M, Bryant N, Tentori F. Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized Controlled Trial. Am J Kidney Dis 2019; 74:351-360. [PMID: 30954312 DOI: 10.1053/j.ajkd.2019.01.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/29/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Annually, about 100,000 US patients face the difficult choice between the most common dialysis types, in-center hemodialysis and peritoneal dialysis. This study evaluated the value of a new decision aid to assist in the choice of dialysis modality. STUDY DESIGN A parallel-group randomized controlled trial to test the efficacy of the decision aid on decision-making outcomes. SETTING & PARTICIPANTS English-speaking US adults with advanced chronic kidney disease and internet access enrolled in 2015. INTERVENTION Participants randomly assigned to the decision aid intervention received information about chronic kidney disease, peritoneal dialysis, and hemodialysis and a value clarification exercise through the study website using their own electronic devices. Participants in the control arm were only required to complete the control questionnaire. Questionnaire responses were used to assess differences across arms in decision-making outcomes. OUTCOMES Treatment preference, decisional conflict, decision self-efficacy, knowledge, and preparation for decision making. RESULTS Of 234 consented participants, 94 (40.2%) were lost to follow-up before starting the study. Among the 140 (70 in each arm) who started the study, 7 were subsequently lost to follow-up. Decision aid users had lower decisional conflict scores (42.5 vs 29.1; P<0.001) and higher average knowledge scores (90.3 vs 76.5; P<0.001). Both arms had high decisional self-efficacy scores independent of decision aid use. Uncertainty about choice of dialysis treatment declined from 46% to 16% after using the decision aid. Almost all (>90%) users of the decision aid reported that it helped in decision making. LIMITATIONS Limited generalizability from the study of self-selected study participants who had to have internet access, speak English, and have computer literacy. High postrandomization loss to follow-up. Evaluation of only short-term outcomes. CONCLUSIONS The decision aid improves decision-making outcomes immediately after use. Implementation of the decision aid in clinical practice may allow further assessment of its effects on patient engagement and empowerment in choosing a dialysis modality. FUNDING This study was funded through a Patient Centered Outcomes Research Institute (PCORI) award (#1109). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT02488317.
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Affiliation(s)
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI.
| | - Megan Knaus
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT; Salt Lake City VA Center for Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT
| | - Erica Perry
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | - Francesca Tentori
- Vanderbilt University, Nashville, TN; Davita Clinical Research, Minneapolis, MN
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Briggs V, Davies S, Wilkie M. International Variations in Peritoneal Dialysis Utilization and Implications for Practice. Am J Kidney Dis 2019; 74:101-110. [PMID: 30799030 DOI: 10.1053/j.ajkd.2018.12.033] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/11/2018] [Indexed: 12/21/2022]
Abstract
In many countries, the use of peritoneal dialysis (PD) remains low despite arguments that support its greater use, including dialysis treatment away from hospital settings, avoidance of central venous catheters, and potential health economic advantages. Training patients to manage aspects of their own care has the potential to enhance health literacy and increase patient involvement, independence, quality of life, and cost-effectiveness of care. Complex reasons underlie the variable use of PD across the world, acting at the level of the patient, the health care team that is responsible for them, and the health care system that they find themselves in. Important among these is the availability of competitively priced dialysis fluid. A number of key interventions can affect the uptake of PD. These include high-quality patient education around dialysis modality choice, timely and successful catheter placement, satisfactory patient training, and continued support that is tailored for specific needs, for example, when people present late requiring dialysis. Several health system changes have been shown to increase PD use, such as targeted funding, PD First initiatives, or physician-inserted PD catheters. This review explores the factors that explain the considerable international variation in the use of PD and presents interventions that can potentially affect them.
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Affiliation(s)
| | | | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, United Kingdom.
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38
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Mahmoodi N, Bekker HL, King NV, Hughes J, Jones GL. Are publicly available internet resources enabling women to make informed fertility preservation decisions before starting cancer treatment: an environmental scan? BMC Med Inform Decis Mak 2018; 18:104. [PMID: 30453942 PMCID: PMC6245564 DOI: 10.1186/s12911-018-0698-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/26/2018] [Indexed: 12/02/2022] Open
Abstract
Background To identify publicly available internet resources and assess their likelihood to support women making informed decisions about, and between, fertility preservation procedures before starting their cancer treatment. Methods A survey of publically available internet resources utilising an environmental scan method. Inclusion criteria were applied to hits from searches of three data sources (November 2015; repeated June 2017): Google (Chrome) for patient resources; repositories for clinical guidelines and projects; distribution email lists to contact patient decision aid experts. The Data Extraction Sheet applied to eligible resources elicited: resource characteristics; informed and shared decision making components; engagement health services. Results Four thousand eight hundred fifty one records were identified; 24 patient resources and 0 clinical guidelines met scan inclusion criteria. Most resources aimed to inform women with cancer about fertility preservation procedures and infertility treatment options, but not decision making between options. There was a lack of consistency about how health conditions, decision problems and treatment options were described, and resources were difficult to understand. Conclusions Unless developed as part of a patient decision aid project, resources did not include components to support proactively women’s fertility preservation decisions. Current guidelines help people deliver information relevant to treatment options within a single disease pathway; we identified five additional components for patient decision aid checklists to support more effectively people’s treatment decision making across health pathways, linking current with future health problems. Electronic supplementary material The online version of this article (10.1186/s12911-018-0698-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - H L Bekker
- Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - N V King
- Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - J Hughes
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
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39
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Pyart R, Donovan K, Carrington C, Roberts G. Peritoneal Dialysis: Turning Choice into Reality. Perit Dial Int 2018; 38:328-333. [DOI: 10.3747/pdi.2018.00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/26/2018] [Indexed: 11/15/2022] Open
Abstract
Background Peritoneal dialysis (PD) utilization rates vary widely between UK renal centers. Currently there are only limited data available on how many patients choose PD but subsequently fail to start their chosen modality. In the current analysis we sought to explore the outcomes of patients who chose PD in our center where all PD catheters are inserted via a mini-laparotomy with no acute-start PD service. Methods We retrospectively analyzed the outcomes of 658 patients over a 12-year period who, following predialysis education had chosen PD as their preferred renal replacement therapy (RRT) modality. Data were collected on patient demographics, start modality, transplantation, patient survival, and the reasons patients failed to start PD. Results Predialysis education was given to 2,749 patients, and 658 (24%) chose PD. Of the 566 (86%) who either started RRT or died, less than half started PD ( n = 273, 48%). The commonest reason to start hemodialysis (HD) was an acute decline in kidney function leading to an effective ‘unplanned’ start on RRT. As a result, despite adjusting for older age and higher comorbidity, the transplant-censored survival at 3 years from the time of start of RRT was predictably worse in patients starting HD. Less than half the patients who started HD went on to commence PD later. Conclusion Unanticipated decline in kidney function leading to unplanned start on HD contributes to the worse outcomes associated with failing to start PD. How and when we insert PD catheters appears to be key, and we have identified ways to improve our service.
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Affiliation(s)
- Rhodri Pyart
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, United Kingdom
| | - Kieron Donovan
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, United Kingdom
| | - Christopher Carrington
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, United Kingdom
| | - Gareth Roberts
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, United Kingdom
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Brown EA, Bargman J, van Biesen W, Chang MY, Finkelstein FO, Hurst H, Johnson DW, Kawanishi H, Lambie M, de Moraes TP, Morelle J, Woodrow G. Length of Time on Peritoneal Dialysis and Encapsulating Peritoneal Sclerosis - Position Paper for ISPD: 2017 Update. Perit Dial Int 2018; 37:362-374. [PMID: 28676507 DOI: 10.3747/pdi.2017.00018] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 04/04/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Joanne Bargman
- University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Ming-Yang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Helen Hurst
- Central Manchester and Manchester Children's NHS Foundation Trust, Manchester, UK
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Hideki Kawanishi
- Tsuchiya General Hospital, Faculty of Medicine, Hiroshima University, Japan
| | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Stoke-on-Trent, UK
| | | | - Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium, et Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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Hackett J, Bekker H, Bennett MI, Carder P, Gallagher J, Henry C, Kite S, Taylor S, Velikova G, Ziegler L. Developing a complex intervention to support timely engagement with palliative care for patients with advanced cancer in primary and secondary care in the UK: a study protocol. BMJ Open 2018; 8:e022835. [PMID: 29764891 PMCID: PMC5961581 DOI: 10.1136/bmjopen-2018-022835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION For patients with advanced cancer, timely access to palliative care can improve quality of life and enable patients to participate in decisions about their end-of-life care. However, in a UK population of 2500 patients who died from cancer, one-third did not receive specialist palliative care, and of those who did, the duration of involvement was too short to maximise the benefits. Initiating a conversation about palliative care is challenging for some health professionals and patients often have unmet information needs and misconceptions about palliative care. We will work closely with patients and health professionals to develop a patient decision aid and health professional training module designed to facilitate a timely and informed conversation about palliative care. METHODS AND ANALYSIS This study is being conducted over 24 months from November 2017 to October 2019 and follows the UK Medical Research Council framework for developing complex interventions and the International Patient Decision Aids Guideline. The Ottawa Decision Support Framework underpins the study. The Supporting Timely Engagement with Palliative care (STEP) intervention will be developed though an iterative process informed by interviews and focus groups with patients with advanced cancer, oncologists, general practitioners and palliative care doctors. An expert panel will also review each iteration. The expert panel will consist of a patient representative with experience of palliative care, health professionals who are involved in advanced cancer care decision-making, a medical education expert and the National Council for Palliative Care director of transformation. The feasibility and acceptability of the decision aid and doctor training will be tested in oncology and general practice settings. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Office for Research Ethics Committees Northern Ireland (ORECNI), approval reference 17/NI/0249. Dissemination and knowledge transfer will be conducted via publications, national bodies and networks, and patient and family groups.
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Affiliation(s)
- Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hilary Bekker
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Carder
- NHS Bradford and Districts CCGs, Bradford, UK
| | - Jean Gallagher
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Suzanne Kite
- Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Galina Velikova
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Winterbottom AE, Bekker HL, Russon L, Hipkiss V, Ziegler L, Williams R, Mooney A. Dialysis vs conservative management decision aid: a study protocol. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/jokc.2018.3.3.179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Anna E Winterbottom
- Research Psychologist, Adult Renal Services, Lincoln Wing, St James's University Hospital, Leeds
| | - Hilary L Bekker
- Professor of Medical Decision Making, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Lynne Russon
- Consultant, Palliative Medicine. Leeds Teaching Hospitals Trust and Sue Ryder Care, Wheatfields Hospice, Leeds
| | - Vicki Hipkiss
- Senior Sister, St Luke's Hospital, Bradford, West Yorkshire
| | - Lucy Ziegler
- Yorkshire Cancer Research Academic Fellow, Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | | | - Andrew Mooney
- Consultant Renal Physician. Adult Renal Services, St James's University Hospital, Leeds
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Hoffman AS, Sepucha KR, Abhyankar P, Sheridan S, Bekker H, LeBlanc A, Levin C, Ropka M, Shaffer V, Stacey D, Stalmeier P, Vo H, Wills C, Thomson R. Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature. BMJ Qual Saf 2018; 27:389-412. [PMID: 29467235 PMCID: PMC5965363 DOI: 10.1136/bmjqs-2017-006985] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/27/2017] [Accepted: 11/26/2017] [Indexed: 12/27/2022]
Abstract
This Explanation and Elaboration (E&E) article expands on the 26 items in the Standards for UNiversal reporting of Decision Aid Evaluations guidelines. The E&E provides a rationale for each item and includes examples for how each item has been reported in published papers evaluating patient decision aids. The E&E focuses on items key to reporting studies evaluating patient decision aids and is intended to be illustrative rather than restrictive. Authors and reviewers may wish to use the E&E broadly to inform structuring of patient decision aid evaluation reports, or use it as a reference to obtain details about how to report individual checklist items.
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Affiliation(s)
- Aubri S Hoffman
- Department of Family Medicine and Emergency Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karen R Sepucha
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Purva Abhyankar
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Stacey Sheridan
- The Reaching for High Value Care Team, Chapel Hill, North Carolina, USA
| | - Hilary Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Carrie Levin
- Research (April 2014-November 2016), Healthwise Incorporated, Boston, Massachusetts, USA
| | - Mary Ropka
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Victoria Shaffer
- Health Sciences and Psychological Sciences, University of Missouri Health, Columbia, Missouri, USA
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Peep Stalmeier
- Health Evidence, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Celia Wills
- College of Nursing, Ohio State University, Columbus, Ohio, USA
| | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Finderup J, Jensen JKD, Lomborg K. Developing and pilot testing a shared decision-making intervention for dialysis choice. J Ren Care 2018; 44:152-161. [PMID: 29664179 DOI: 10.1111/jorc.12241] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence is inconclusive on how best to guide the patient in decision-making around haemodialysis and peritoneal dialysis choice. International guidelines recommend involvement of the patient in the decision to choose the dialysis modality most suitable for the individual patient. Nevertheless, studies have shown lack of involvement of the patient in decision-making. OBJECTIVES To develop and pilot test an intervention for shared decision-making targeting the choice of dialysis modality. METHODS This study reflects the first two phases of a complex intervention design: phase 1, the development process and phase 2, feasibility and piloting. Because decision aids were a part of the intervention, the International Patient Decision Aid Standards were considered. The pilot test included both the intervention and the feasibility of the validated shared decision-making questionnaire (SDM Q9) and the Decision Quality Measure (DQM) applied to evaluate the intervention. RESULTS A total of 137 patients tested the intervention. After the intervention, 80% of the patients chose dialysis at home reflecting an increase of 23% in starting dialysis at home prior to the study. The SDM Q9 showed the majority of the patients experienced this intervention as shared decision-making. CONCLUSION An intervention based on shared decision-making supported by decision aids seemed to increase the number of patients choosing home dialysis. The SDM Q9 and DQM were feasible evaluation tools. Further research is needed to gain insight into the patients' experiences of involvement and the implications for their choice of dialysis modality.
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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
| | - Jens K D Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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45
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O'Hare AM, Song MK, Kurella Tamura M, Moss AH. Research Priorities for Palliative Care for Older Adults with Advanced Chronic Kidney Disease. J Palliat Med 2018; 20:453-460. [PMID: 28463635 DOI: 10.1089/jpm.2016.0571] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Older adults with advanced chronic kidney disease (CKD) often have multiple comorbid conditions, a high symptom burden, and limited life expectancy. There is mounting concern that the intensive patterns of care that many of these patients receive at the end of life are discordant with their values and preferences. The nephrology community has recognized that there are significant unmet palliative care needs in this population. In this article, we identify three broad areas of knowledge deficit where more evidence is needed to support the "best care possible" for this population: (1) what matters most to older adults with advanced CKD and their caregivers near the end of life; (2) how the nephrology community can best support older adults with advanced CKD to navigate complex treatment decisions throughout their illness; and (3) how the healthcare system should be reconfigured to promote patient- and family-centered care for older adults with advanced CKD. Research priorities include identifying opportunities for improving the end-of-life experience of older adults with CKD and their caregivers; developing and testing communication interventions before and during dialysis to ensure that treatment decisions reflect patients' preferences; and assessing the effectiveness of palliative care in improving quality of life for patients and caregivers, satisfaction with care, and aligning treatment decisions with patient goals and preferences.
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Affiliation(s)
- Ann M O'Hare
- 1 Department of Medicine, University of Washington and Veterans Affairs Puget Sound Healthcare System , Seattle, Washington
| | - Mi-Kyung Song
- 2 Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, Georgia
| | | | - Alvin H Moss
- 4 Sections of Nephrology and Supportive Care, West Virginia University School of Medicine , Morgantown, West Virginia
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Abstract
The prevalence of end-stage renal disease is rising in the United States, which bears high financial and public health burden. The most common modality of renal replacement therapy (RRT) in the United States is in-center hemodialysis. Many patients report lack of comprehensive and timely education about their treatment options, which may preclude them from participating in home-based dialysis therapies and kidney transplantation evaluation. While RRT education has traditionally been provided in-person, the rise of telehealth has afforded new opportunities to improve upon the status quo. For example, technology-augmented RRT education has recently been implemented into telehealth nephrology clinics, informational websites and mobile applications maintained by professional organizations, patient-driven forums on social media, and multimodality programs. The benefits of technology in RRT education are increased access for geographically isolated and/or medically frail patients, versatility of content delivery, information repetition to enhance knowledge retention, and interpersonal connection for educational content and emotional support. Challenges center around privacy and accuracy of information sharing, in addition to differential access to technology due to age and socioeconomic status. A review of available scholarly and social media resources suggests that technology-aided delivery of education about treatment options for end-stage renal disease provides an important alternative and/or supplemental resource for patients and families.
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Affiliation(s)
- Anna Malkina
- Division of Nephrology, University of California, San Francisco, CA, USA
| | - Delphine S Tuot
- Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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47
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Fotheringham J, Barnes T, Dunn L, Lee S, Ariss S, Young T, Walters SJ, Laboi P, Henwood A, Gair R, Wilkie M. Rationale and design for SHAREHD: a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on centre based haemodialysis. BMC Nephrol 2017; 18:335. [PMID: 29178891 PMCID: PMC5702083 DOI: 10.1186/s12882-017-0748-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/08/2017] [Indexed: 12/31/2022] Open
Abstract
Background The study objective is to assess the effectiveness and economic impact of a structured programme to support patient involvement in centre-based haemodialysis and to understand what works for whom in what circumstances and why. It implements a program of Shared Haemodialysis Care (SHC) that aims to improve experience and outcomes for those who are treated with centre-based haemodialysis, and give more patients the confidence to dialyse independently both at centres and at home. Methods/Design The 24 month mixed methods cohort evaluation of 600 prevalent centre based HD patients is nested within a 30 month quality improvement program that aims to scale up SHC at 12 dialysis centres across England. SHC describes an intervention where patients who receive centre-based haemodialysis are given the opportunity to learn, engage with and undertake tasks associated with their treatment. Following a 6-month set up period, a phased implementation programme is initiated across 12 dialysis units using a randomised stepped wedge design with 6 centres participating in each of 2 steps, each lasting 6 months. The intervention utilises quality improvement methodologies involving rapid tests of change to determine the most appropriate mechanisms for implementation in the context of a learning collaborative. Running parallel with the stepped wedge intervention is a mixed methods cohort evaluation that employs patient questionnaires and interviews, and will link with routinely collected data at the end of the study period. The primary outcome measure is the number of patients performing at least 5 dialysis-related tasks collected using 3 monthly questionnaires. Secondary outcomes measures include: the number of people choosing to perform home haemodialysis or dialyse independently in-centre by the end of the study period; end-user recommendation; home dialysis establishment delay; staff impact and confidence; hospitalisation; infection and health economics. Discussion The results from this study will provide evidence of impact of SHC, barriers to patient and centre level adoption and inform development of future interventions to support its implementation. Trial registration ISRCTN Number: 93999549, (retrospectively registered 1st May 2017); NIHR Research Portfolio: 31566
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Affiliation(s)
- James Fotheringham
- Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU, Sheffield, UK
| | - Tania Barnes
- Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU, Sheffield, UK
| | - Louese Dunn
- Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU, Sheffield, UK
| | - Sonia Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU, Sheffield, UK
| | - Steven Ariss
- University of Sheffield & NIHR CLAHRC YH, Sheffield, UK
| | - Tracey Young
- University of Sheffield & NIHR CLAHRC YH, Sheffield, UK
| | | | - Paul Laboi
- York Teaching Hospital NHS Foundation Trust, York, UK
| | - Andy Henwood
- York Teaching Hospital NHS Foundation Trust, York, UK
| | | | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Foundation Trust, S5 7AU, Sheffield, UK.
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48
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Combes G, Sein K, Allen K. How does pre-dialysis education need to change? Findings from a qualitative study with staff and patients. BMC Nephrol 2017; 18:334. [PMID: 29169332 PMCID: PMC5701386 DOI: 10.1186/s12882-017-0751-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-dialysis education (PDE) is provided to thousands of patients every year, helping them decide which renal replacement therapy (RRT) to choose. However, its effectiveness is largely unknown, with relatively little previous research into patients' views about PDE, and no research into staff views. This study reports findings relevant to PDE from a larger mixed methods study, providing insights into what staff and patients think needs to improve. METHODS Semi-structured interviews in four hospitals with 96 clinical and managerial staff and 93 dialysis patients, exploring experiences of and views about PDE, and analysed using thematic framework analysis. RESULTS Most patients found PDE helpful and staff valued its role in supporting patient decision-making. However, patients wanted to see teaching methods and materials improve and biases eliminated. Staff were less aware than patients of how informal staff-patient conversations can influence patients' treatment decision-making. Many staff felt ill equipped to talk about all treatment options in a balanced and unbiased way. Patient decision-making was found to be complex and patients' abilities to make treatment decisions were adversely affected in the pre-dialysis period by emotional distress. CONCLUSIONS Suggested improvements to teaching methods and educational materials are in line with previous studies and current clinical guidelines. All staff, irrespective of their role, need to be trained about all treatment options so that informal conversations with patients are not biased. The study argues for a more individualised approach to PDE which is more like counselling than education and would demand a higher level of skill and training for specialist PDE staff. The study concludes that even if these improvements are made to PDE, not all patients will benefit, because some find decision-making in the pre-dialysis period too complex or are unable to engage with education due to illness or emotional distress. It is therefore recommended that pre-dialysis treatment decisions are temporary, and that PDE is replaced with on-going RRT education which provides opportunities for personalised education and on-going review of patients' treatment choices. Emotional support to help overcome the distress of the transition to end-stage renal disease will also be essential to ensure all patients can benefit from RRT education.
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Affiliation(s)
- Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Kim Sein
- Hull York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, B15 2TT, UK
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49
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Dahlan RA, Alsuwaida AO, Farrash MS, Qureshi MA, Hejaili F, Sayyari AAA. Let Us Listen to Patients: Underutilization of Peritoneal Dialysis from Patients’ Perspectives. Perit Dial Int 2017; 37:574-576. [DOI: 10.3747/pdi.2016.00321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite the fact that many of the medical outcome data of peritoneal dialysis (PD) have been improving over the past few years, PD remains an underutilized modality in many countries worldwide. Most nephrologists in those countries report a high rate of patients’ refusal. We conducted this survey-based study to determine the obstacles behind underutilization of PD in Saudi Arabia from patients’ perspectives and to understand the reasons for their refusal. Nine-hundred and twenty hemodialysis (HD) patients, who had never been on PD before, participated in this study. Responses obtained from patients indicate that their refusal of PD could be because they had not received proper counseling and education about PD from their treating nephrologists throughout the course of their disease.
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Affiliation(s)
| | | | | | - Mohammad A. Qureshi
- King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Fayez Hejaili
- King Saud Bin Abdulaziz University for Health Science Riyadh, Saudi Arabia
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50
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McKane WS. Should Nephrologists Promote Peritoneal Dialysis as a Bridge to Transplantation? Perit Dial Int 2017; 37:247-249. [PMID: 28512161 DOI: 10.3747/pdi.2016.00269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- William S McKane
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK
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