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Abstract: PO1697

Want to Reduce Regret with Dialysis Initiation? Implement Shared Decision-Making

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Saeed, Fahad, University of Rochester Medical Center, Rochester, New York, United States
  • Kazi, Basil S., University of Rochester Medical Center, Rochester, New York, United States
  • Mayo, Nicole Lynn, University of Rochester Medical Center, Rochester, New York, United States
  • Dahl, Spencer, University of Rochester Medical Center, Rochester, New York, United States
Background

The American Society of Nephrology’s “Choosing Wisely Campaign” recommends that nephrologists should not initiate chronic dialysis without implementing a shared decision-making (SDM) process. The current literature lacks details on the relationship of SDM with outcomes such as quality of life and decisional regret.

Methods

We surveyed 223/380 (response rate 59%) hospitalized patients receiving maintenance dialysis in the Upstate, NY, and asked them about their experience with dialysis decision-making using the SDM-9 Questionnaire. Quality of life and decisional regret were assessed by KDQ0L-36 and Decisional Regret Scale, respectively. Candidate predictors in the final linear regression model included age, sex, time on dialysis, race, marital status, income level, education level, quality of life, fear of death, and decisional regret.

Results

Nearly 41% of patients were <65 years old, 47% were women, and 41% were White. The mean scores for SDM were 25.9 ± 12.2. In the bivariate analyses, patients who were married or in a relationship had greater mean SDM scores (p<0.01) than those who were single. Patients with higher scores on SDM had less anxiety over death and less decisional regret. (R = -0.17 and -0.29, respectively). The candidate predictors in the final model together explained 21.4% of the variance in SDM (p = 0.02). SDM decreased for every 0.15 unit increase in decisional regret score (CI: -0.25, -0.07) when controlling for all other predictors in the model.

Conclusion

We found that patients with higher scores on the SDM-9 Questionnaire had less decisional regret regarding their decision to initiate dialysis. Future interventions to implement SDM in clinical settings are a top research priority.

Funding

  • Private Foundation Support