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Kidney Week

Abstract: SA-PO745

Patient-Reported Experiences of a Shared Decision-Making Process on Dialysis or Conservative Care

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Verberne, Wouter, St Antonius Hospital, Nieuwegein, Netherlands
  • Bos, Willem Jan W., St Antonius Hospital, Nieuwegein, Netherlands
Background

Older patients approaching end-stage renal disease face the decision whether to start dialysis, or conservative care (CC)—which is argued to be a reasonable treatment option, particularly in the oldest old and those with severe comorbidity. Shared decision-making has been recommended to align treatment plans with the patient’s values and preferences. Little is known regarding experiences of patients with such decision-making process.

Methods

We developed a questionnaire in collaboration with the Dutch Kidney Patients Association to assess older patients’ experiences of their decision-making process on choosing dialysis or CC. We included 99 patients with stage 4/5 CKD and aged ≥70 years, who had chosen dialysis (n=75) or CC (n=24). A shared decision-making process had been initiated by a multidisciplinary team when the estimated glomerular filtration rate fell below 20 mL/min/1.73m2, and included in-depth discussions in which oral and/or written information was given about dialysis and CC.

Results

Overall, patients stated to be satisfied with the decision-making process (median score on a 11-point Likert scale; dialysis group: 8.0 vs. CC group: 9.0; p = 0.06), as well as with their treatment decision (8.0 vs. 9.0; p = 0.07). Most felt they had enough time (79% vs. 87%) and information (80% vs. 73%) to make a decision, although factors as more time, information, and deliberation were mentioned as potential improvements. Patients choosing dialysis reported life prolongation and feeling of lack of choice as important reasons for their decision, whereas quality of life and treatment burden were important reasons in choosing CC. 53% of the patients in the dialysis group considered their own opinion as most important in their treatment choice compared to 95% in the CC group (p = 0.003). More patients in the dialysis group felt forced by the situation to make a decision (32% vs. 4%; p = 0.01), or still doubted their treatment decision (17% vs. 0%; p = 0.03).

Conclusion

In this small Dutch sample, older kidney patients reported to be overall satisfied with a shared decision-making process on choosing dialysis or CC, although some had important recommendations for improvement. Patients had contrasting reasons for their treatment choice. Patients choosing CC experienced more autonomy and ownership in their decision-making.

Funding

  • Commercial Support