Abstract: FR-OR097
Easing the Difficult Job of Giving "Bad News": Using a Decision Aid to Match Patient Values to a Dialysis Modality
Session Information
- Shaping the Future of Nephrology Education
October 26, 2018 | Location: 6F, San Diego Convention Center
Abstract Time: 04:54 PM - 05:06 PM
Category: Educational Research
- 800 Educational Research
Authors
- Wise, Meg, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Schatell, Dorian R., Medical Education Institute, Madison, Wisconsin, United States
- Chewning, Betty, University of Wisconsin-Madison, Madison, Wisconsin, United States
- Chan, Micah R., University of Wisconsin-Madison, Madison, Wisconsin, United States
- Ashfaq, Akhtar, Opko Pharmaceuticals, Westbury, New York, United States
Background
Nephrologists say telling patients they need dialysis is the worst part of the job—and patients do not want this "bad news". Yet, little is known about how nephrologists describe the options or tailor information to patients’ values—or whether decision support can make this challenging topic less traumatic and more effective.
Methods
Design: A 2-phase prospective, intervention study of audiorecorded conversations between nephrologists and stage 4-5 non-dialysis CKD patients at 2 WI clinics.
Phase 1: 6 nephrologists and 32 patients; no decision support offered.
Phase 2: 6 nephrologists and 30 patients; patients used an online, values-based decision aid—My Life, My Dialysis Choice (My Life) before the visit and shared the 1-page summary of their values/dialysis preferences with the nephrologist.
Data: Phase 1 vs. Phase 2: conversations for tailoring information to (1) Values, (2) Patients’ surveys for dialysis preference, and (3) Nephrologists’ surveys.
Results
Results
Sample: Nephrologists had a mean age of 40 and 7.5 mean years of practice. Patients’ mean eGFR was 20; mean age was 70; 90% were non-Hispanic white; 73% did not finish college.
Phase 1: The dialysis conversation segment was the most difficult. 0% of nephrologists elicited patients’ values. Nephrologists tailored dialysis information for only the 4 (13%) activated patients who inserted their values; 4 (13%) patients preferred home dialysis. Nephrologists said they wanted a tool to aid the dialysis discussion.
Phase 2: The summary served as a dialysis conversation icebreaker. Nephrologists proactively addressed patients’ values 97% of the time and tailored their modality information accordingly (P<0.001 vs. Phase 1). Nephrologists said it “alleviated the need to give bad news.” 15 (50%) patients preferred home dialysis (P <0.01 vs. Phase 1).
Conclusion
Patient use of My Life (~20 minutes) eased a difficult conversation for both nephrologists and patients, and increased patient preference for home dialysis modalities in this small study.
Conversation Analysis Results
| Conversation Analysis | Phase 1: No Decision Aid n=32 | Phase 2: Decision aid n=30 | P value |
| MD elicited/addressed patients | 0 (0%) | 29 (97%) | <0.001 |
| Patients inserted their own values | 4 (13%) | 0 (0%) | <0.001 |
| POST-VISIT PATIENT SURVEY | |||
| Would choose home dialysis | 4 (13%) | 15 (50%) | <0.01 |
| Undecided about a type of dialysis | 12 (38%) | 6 (20%) | 0.134 |
Funding
- Commercial Support – Amgen supported Phase 1