Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease

Abstract

Objective To evaluate the effectiveness of shared decision-making (SDM) interventions to improve the quality of dialysis decision-making in patients with end-stage renal disease. Methods A randomized controlled was carried out in 72 patients with end-stage renal disease recruited between October 2021 and December 2021. The patients were randomly assigned into the intervention group (n=36) or the control group (n=36). The intervention group was given SDM interventions in which the nurses used patient decision aids (PDA) for decision-making counseling, while the control group was given routine pre-dialysis education. All patients received the surveys of Decision Conflict Scale, Treatment Choice Questionnaire, Hospital Anxiety and Depression Scale, and Decision Readiness Scale in 1 week after the intervention, and 36-Item Short Form Health Survey (SF-36) and Decision Regret Scale in 3 months after dialysis. The primary endpoint indicator was the score of Decision Conflict Scale, and the secondary ones were treatment choice, and scores of anxiety and depression, decision readiness, quality of life, and decision regret. Results After 1 week of intervention, the scores of decision conflict (P < 0.01) and anxiety (P=0.005) were significantly lower, while that of decision preparation (P < 0.01) was obviously higher in the intervention group than the control group. The proportion of uncertainty to dialysis in the intervention group was significantly lower than that of the control group (15.15% vs 34.29%, P=0.026). In 3 months after dialysis, the intervention group obtained statistically higher total physiological score (P=0.004) and lower decision regret score (P=0.002) when compared with the control group. Conclusion SDM interventions can effectively reduce decision conflict and decision regret, reduce anxiety level, and improve decision preparation and physiological health for the patients with end-stage renal disease.

Keywords

• shared decision-making
• end-stage renal disease
• hemodialysis
• peritoneal dialysis
• patient decision aids
• decision coaching