Abstract
Rationale & Objective: Older adults with advanced chronic kidney disease (CKD) face difficult decisions about dialysis initiation. Although shared decision making (SDM) can help align patient preferences and values with treatment options, the extent to which older patients with CKD experience SDM remains unknown. Study Design: A cross-sectional analysis of patient surveys examining decisional readiness, treatment options education, care partner support, and SDM. Setting & Participants: Adults aged 70 years or older from Boston, Chicago, San Diego, or Portland (Maine) with nondialysis advanced CKD. Predictors: Decisional readiness factors, treatment options education, and care partner support. Outcomes: Primary: SDM measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) instrument, with higher scores reflecting greater SDM. Exploratory: Factors associated with SDM. Analytical Approach: We used multivariable linear regression models to examine the associations between SDM and predictors, controlling for demographic and health factors. Results: Among 350 participants, mean age was 78 ± 6 years, 58% were male, 13% identified as Black, and 48% had diabetes. Mean SDM-Q-9 score was 52 ± 28. SDM item agreement ranged from 41% of participants agreeing that “my doctor and I selected a treatment option together” to 73% agreeing that “my doctor told me that there are different options for treating my medical condition.” In multivariable analysis adjusted for demographic characteristics, lower estimated glomerular filtration rate, and diabetes, being “well informed” and “very well informed” about kidney treatment options, having higher decisional certainty, and attendance at a kidney treatment options class were independently associated with higher SDM-Q-9 scores. Limitations: The cross-sectional study design limits the ability to make temporal associations between SDM and the predictors. Conclusions: Many older patients with CKD do not experience SDM when making dialysis decisions, emphasizing the need for greater access to and delivery of education for individuals with advanced CKD.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 599-609 |
| Number of pages | 11 |
| Journal | American Journal of Kidney Diseases |
| Volume | 80 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2022 |
Funding
Research reported in this work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CDR-2017C1-6297) to Drs Ladin and Weiner. Dr Isakova was supported by National Heart, Lung, and Blood Institute grant K24HL150235. Dr Frazier was supported by National Institute of Diabetes and Digestive and Kidney Diseases grant P30DK114857 and a National Kidney Foundation of Illinois Young Investigator Grant. The funders did not have a role in study design, data collection, analysis, reporting, or the decision to submit for publication. Rebecca Frazier, MD, Sarah Levine, BA, Thalia Porteny, PhD, MSc, Hocine Tighiouart, MS, John B. Wong, MD, Tamara Isakova, MD, MMSc, Susan Koch-Weser, ScD, Elisa J. Gordon, PhD, MPH, Daniel E. Weiner, MD, MS, and Keren Ladin, PhD, MSc. Designed the current study: KL, DEW, EJG, SK-W, TI, JBW; collected the DART Trial data: SL, TP; analyzed the data: HT; interpreted the data: KL, DEW, EJG, SK-W, TI, JBW, RF. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. Research reported in this work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (CDR-2017C1-6297) to Drs Ladin and Weiner. Dr Isakova was supported by National Heart, Lung, and Blood Institute grant K24HL150235. Dr Frazier was supported by National Institute of Diabetes and Digestive and Kidney Diseases grant P30DK114857 and a National Kidney Foundation of Illinois Young Investigator Grant. The funders did not have a role in study design, data collection, analysis, reporting, or the decision to submit for publication. Dr Isakova received consulting honorariums from Akebia Therapeutics, Inc. Dr Weiner has received consulting honoraria from Akebia Therapeutics (paid to Dialysis Clinic, Inc) and Cara Therapeutics. The remaining authors declare that they have no relevant financial interests. The views presented in this publication are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors, or Methodology Committee, or the position or policy of the Department of Veterans Affairs or the US government. The data underlying this article cannot be shared publicly to protect the privacy of the individuals who participated in the study. Aspects of this work were presented in abstract form on October 19, 2021, at the Society for Medical Decison Making virtual conference, and on November 4, 2021, at the American Society of Nephrology Kidney Week 2021 virtual conference. Received November 3, 2021. Evaluated by 3 external peer reviewers and a statistician, with editorial input from an Acting Editor-in-Chief (Editorial Board Member David W. Johnson, MBBS, FRACP, PhD). Accepted in revised form Feb 9, 2022. The involvement of an Acting Editor-in-Chief to handle the peer-review and decision-making processes was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.
Keywords
- Shared decision making (SDM)
- chronic kidney disease (CKD)
- comprehensive conservative care
- dialysis
- dialysis initiation
- education
- end-stage renal disease (ESRD)
- geriatric nephrology
- health-related quality of life (HRQOL)
- older adults
- patient-centered care
ASJC Scopus subject areas
- Nephrology
