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ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

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Kidney Week

Abstract: TH-PO237

Effectiveness of Decision Aids in Promoting Knowledge and Shared Decision Around Treatment for ESRD: A Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Thorsteinsdottir, Bjoerg, Mayo Clinic, Rochester, Minnesota, United States
  • Pawar, Aditya S., Mayo Clinic, Rochester, Minnesota, United States
  • Hickson, LaTonya J., Mayo Clinic, Rochester, Minnesota, United States
  • Wirtz, Cristina, Mayo Clinic, Rochester, Minnesota, United States
  • Tangri, Navdeep, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
  • Shah, Nilay D., Mayo Clinic, Rochester, Minnesota, United States
Background

Renal replacement therapy (RRT) for end stage renal disease (ESRD) is a preference-sensitive decision yet patients do not perceive they have a choice. Guidelines have called for increased shared decision making in this space especially for higher risk patients for whom there is equipoise regarding the balance of benefits and harms. Decision aids have been proposed to ensure goal concordant care. We systematically reviewed the performance of decision aids for ESRD treatment choice.

Methods

Multiple databases were searched for comparative studies of using decision aids to help advanced kidney failure patients choose between different types of RRT from inception to January 30, 2018.
PRISMA guidelines were followed with two reviewers independently screening abstracts, performing full text assessment of inclusion criteria and extracting study design, outcomes and risk of bias.

Results

Of 1083 articles screened and 90 reviewed in full text, 10 were included, tested in a total of 1114 patients (range 35-569). There was great heterogeneity of measured and reported outcomes and few used validated tools. Pre-planned meta-analyses of knowledge showed significant increase in standardized mean difference of 0.598 but with high heterogeneity I2 61%.

Conclusion

Decision aids appear to increase patient knowledge in ESRD but their outcome reporting is heterogeneous which limits the strength of inferences. To move the field forward, international consensus is needed on the most meaningful outcome measures and best practices in future decision aid research.

Funding

  • NIDDK Support