Supporting Shared Decision-Making and Home Dialysis in End-Stage Kidney Disease

Abstract

Rebecca Campbell-Montalvo,1,2 Huanguang Jia,2 Ashutosh M Shukla2,3 1Department of Curriculum and Instruction, Neag School of Education, University of Connecticut, Storrs, CT, USA; 2Department of Medicine, North Florida/South Georgia Veteran Healthcare System, Gainesville, FL, USA; 3Division of Nephrology, Hypertension and Transplantation, Department of Medicine, University of Florida, Gainesville, FL, USACorrespondence: Ashutosh M Shukla, North Florida South Georgia Veteran Healthcare System, Division of Nephrology, Hypertension and Transplantation, University of Florida, 1600 Archer Road, Gainesville, FL, 32610, USA, Tel [phone], Fax [phone], Email [email protected]: It has been widely demonstrated that patient education and empowerment, especially involving shared treatment decisions, improve patient outcomes in chronic medical conditions, including chronic kidney disease requiring kidney replacement therapies. Accordingly, regulatory agencies in the US and worldwide recommend shared decision-making for finalizing one’s choice of kidney replacement therapy. It is also recognized that the US needs to substantially increase home dialysis utilization to leverage its positive impacts on patient and healthcare cost-related outcomes. This perspective highlights how the routine clinical use of the recommended practice of shared decision-making can exist in synergy with the system’s goal for increased home dialysis use. It introduces a pragmatic provider checklist, The Nephrologist’s Shared Decision-Making Checklist, grounded in the relevant theories of shared decision-making, and, unlike some research assessments and extant tools, is easy to understand and implement in clinical practice. This qualitative Checklist can help providers ensure that they have co-constructed an SDM experience with the patient and involved caretakers, helping them benefit from the improved outcomes associated with SDM.Keywords: shared decision-making, informed decision-making, kidney failure, end-stage renal disease, home dialysis, patient engagement, patient empowerment

Keywords

• shared decision making
• informed decision making
• kidney failure
• end stage renal disease
• home dialysis
• patient engagement
• patient empowerment