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Abstract: PO1368

Shared Decision-Making Among Older Adults with Advanced CKD

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Frazier, Rebecca, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Levine, Sarah, Tufts Medical Center, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Wong, John B., Tufts Medical Center, Boston, Massachusetts, United States
  • Isakova, Tamara, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Koch-Weser, Susan, Tufts University, Medford, Massachusetts, United States
  • Gordon, Elisa J., Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Ladin, Keren, Tufts University, Medford, Massachusetts, United States
Background

Older adults with advanced chronic kidney disease (CKD) face difficult, preference-sensitive decisions about dialysis. Although shared decision-making (SDM) can help align treatment with patient preferences and values, the degree to which older CKD patients experience SDM and associated factors remain unknown.

Methods

Using data from the Decision Aid for Renal Therapy Trial, we examined SDM in adults >70 years with non-dialysis CKD stage 4–5 from 4 sites in the US using the validated SDMQ9 measure, with scores scaled from 0-100 and higher scores reflecting greater SDM. We categorized predictors into demographic and clinical factors, cognitive factors (decisional perception and uncertainty), and behavioral and educational factors (resources supporting SDM). Multivariable linear regression assessed predictors of SDM.

Results

Among 350 participants, mean age was 78±6 years, 58% were male, 13% were Black, and 48% had diabetes. Mean SDMQ9 score was 52±28. Responses varied from 73% somewhat, strongly, or completely agreeing that “My doctor told me that there are different options for treating my medical condition,” to just 41% agreeing that “My doctor and I selected a treatment option together” (Figure). In regression analyses, being “very well informed” about kidney treatment options (β=14.9, p=0.02), Black race (β=10.4, p=0.02), attended a dialysis class (β=8.3, p=0.02), diabetes (β=7.9, p=0.007), older age (β=5.2, p=0.04), lower eGFR (β=-2.4, p=0.02), and higher decisional certainty (β=1.5, p=0.002) were associated with higher SDMQ9 scores. In models evaluating behavioral/educational factors, dialysis class attendance (β=8.8, p=0.009) and care satisfaction (β=2.4, p=0.02) were associated with higher scores.

Conclusion

There is room for improvement in SDM for many older CKD patients who face preference-sensitive dialysis decisions. Being well-informed about treatment options, increased decision certainty, and dialysis options class attendance were associated with SDM, suggesting that education is critical to the SDM process.

Funding

  • Private Foundation Support