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Kidney Week

Abstract: PO1369

A Qualitative Study of Patient-Clinician Dyads on Perceived Challenges to Shared Decision-Making About Treatment of Advanced CKD

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • House, Taylor R., University of Washington, Seattle, Washington, United States
  • Wightman, Aaron G., University of Washington, Seattle, Washington, United States
  • Rosenberg, Abby R., University of Washington, Seattle, Washington, United States
  • Abdel-Kader, Khaled, Vanderbilt University, Nashville, Tennessee, United States
  • Wong, Susan P.Y., University of Washington, Seattle, Washington, United States
Background

An important step to implementation of shared decision-making for treatment of advanced CKD is acquiring a deeper understanding of its perceived challenges.

Methods

We performed a qualitative study using in-depth interviews with 29 patients aged ≥65 years with advanced CKD and 10 of their clinicians. We also reviewed patients’ electronic health records and abstracted passages containing further information on treatment of their advanced CKD. We used thematic analysis to analyze interview transcripts and note passages and identify emergent themes reflecting their joint experiences with decision-making about treatment of their advanced CKD.

Results

Patients (age 73±6 years) were mostly men (66%) and Caucasian (59%). Of the clinicians (age 52±12 years, 30% male, 70% Caucasian) who participated in interviews, 4 (40%) were non-nephrologists. Four themes emerged from qualitative analysis: 1) Competing priorities: patients and their clinicians tended to differ on when to triage CKD and dialysis planning above other priorities; 2) Focusing on present or future: patients and their clinicians could be misaligned on their outlook on CKD, with patients being more focused on living well now; and clinicians, on preparing for dialysis and future adverse events; 3) Textbook approach to CKD: patients perceived their clinicians as taking a monolithic approach to CKD that was predicated on clinical practice guidelines and medical literature rather than their lived experience with illness, while clinicians were uncertain about how to incorporate patients’ personal values and goals into decision-making; and 4) Power dynamics: while patients described cautiously navigating a power differential between themselves and their clinicians, clinicians seemed less attuned to these power dynamics.

Conclusion

Improving shared decision-making for treatment of advanced CKD will likely require efforts that explicitly reconcile the differences in mindset between patients and their clinicians on decision-making about treatment of advanced CKD and that address the power imbalances in their therapeutic relationship.

Funding

  • NIDDK Support