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Kidney Week

Abstract: FR-PO325

Are Patients' Needs for Shared and Informed Decision Making About Kidney Replacement Therapy Being Addressed?

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Barrett, Tyler M., Duke University, Durham, North Carolina, United States
  • Green, Jamie Alton, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Ephraim, Patti, Johns Hopkins University , Baltimore, Maryland, United States
  • Peskoe, Sarah B., Duke University, Durham, North Carolina, United States
  • Pendergast, Jane F., Duke University, Durham, North Carolina, United States
  • Strigo, Tara Smith, Duke University, Durham, North Carolina, United States
  • Hauer, Chelsie, Geisinger Medical Center, Danville, Pennsylvania, United States
  • Hill-Briggs, Felicia, Johns Hopkins University , Baltimore, Maryland, United States
  • Browne, Teri, University of South Carolina, Columbia, South Carolina, United States
  • Jackson, George L., Durham VA Medical Center, Durham, North Carolina, United States
  • Greer, Raquel C., Johns Hopkins University , Baltimore, Maryland, United States
  • Diamantidis, Clarissa Jonas, Duke University, Durham, North Carolina, United States
  • Boulware, L. Ebony, Duke University, Durham, North Carolina, United States
Background

Little is known about how patients perceive shared and informed decision making (SDM) about kidney replacement therapy.

Methods

As part of the PREPARE NOW trial, we asked adults with CKD if they desired shared decision making [SDM] about CKD treatments (i.e., “the doctor and I make the final decisions together”). We also asked participants to what extent they had discussed different kidney replacement treatments and potential treatment impacts with their kidney treatment teams as well as their satisfaction with discussions. We derived 2-year kidney failure risks from medical records. In multivariable models, we quantified associations of participants’ characteristics with treatment discussions and associations of discussion quality with participant satisfaction.

Results

Among 456 participants, 322 (70.6%) desired SDM. These 322 had a mean (SD) age of 70.2 (12.7) years, 60% were female, 96% White, and 62% high school or less educated. They received nephrology care for a median (IQR) of 3.85 (1.94-6.49) years. Half (52%) saw their nephrologists at least every 6 months, and 17% had a 2-year risk of kidney failure >10%. Only a third (35%, n=113) of those desiring SDM had discussed any treatments (peritoneal dialysis [45%], in-center hemodialysis [86%], home hemodialysis [50%], kidney transplant [59%], and conservative management [70%]). Few discussed treatment impacts on their finances (26%), family’s wellbeing (29%), need for help from family (37%), length of life (49%), or quality of life (60%). Still, a majority (64.6%) were ‘completely’ satisfied with discussions. After adjustment, those seeing nephrologists for longer had greater odds of having discussed transplant (OR [95% CI]: 1.16 [1.02-1.32] per 1-year increase, p=0.02). Those whose teams discussed more modalities (OR [95% CI]: 1.66 [1.19-2.33], p<0.01) or treatment impacts (OR [95% CI]: 1.69 [1.26-2.27], p<0.01) had greater odds of being ‘completely’ satisfied.

Conclusion

Most patients prefer sharing CKD treatment decisions with their physicians, but treatment discussions are infrequent and do not address key treatment aspects. More frequent and thorough discussions could improve patients’ SDM experiences.