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Abstract: FR-PO881

Perceptions of Shared Decision-Making and Preferences for Engagement Among Older Adults with CKD: A Mixed-Methods Study

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Kennefick, Kristen, Tufts University, Medford, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Ladin, Keren, Tufts University, Medford, Massachusetts, United States

Group or Team Name

  • DART Team.
Background

Older adults with advanced chronic kidney disease (CKD) face preference-sensitive decisions regarding dialysis initiation. Although shared decision-making (SDM) is recommended, clinicians are unsure how to best facilitate SDM and few CKD patients report experiencing SDM. This study characterizes clinician perspectives on SDM and patient preferences for engagement.

Methods

A mixed-method, longitudinal analysis of surveys and semi-structured interviews was conducted with English-speaking adults 70 years or older with CKD stages 4-5 in Boston, Chicago, San Diego, or Portland (ME) as part of the Decision Aid for Renal Therapy (DART) Trial. Patients’ preferences for engagement were measured using the validated Control Preferences Scale (CPS), which categorizes patients as preferring active, collaborative, or passive engagement. Semi-structured interviews were conducted with a subset of purposively sampled patients and clinicians at these four sites. We used descriptive statistical analysis to examine quantitative data, and thematic and narrative analyses to examine qualitative data.

Results

Among 363 patient-participants at baseline, 42% were female, 13% identified as Black, and 21% had high school education or less. Overall, 92% preferred to play an active or collaborative role in decision-making. CPS preferences were stable throughout; at the individual level, only 4.6% demonstrated a major change (active to passive or passive to active) between baseline and first follow-up. A subset of 75 participants (44 patients and 31 clinicians) completed qualitative interviews, contributing to four qualitative themes: 1) active and collaborative control preferences tied to patient engagement; 2) clinicians constrain information flow; 3) patients with collaborative and active preferences want free-flowing information; and 4) clinician responsiveness to control preference tied to patient satisfaction.

Conclusion

Older adults with advanced CKD overwhelmingly preferred collaborative or active roles, with more prognostic information earlier in the process. Utilizing the single-item CPS may be a simple and effective way for clinicians to assess patients’ preferred level of engagement and determine the flow of information.

Funding

  • Private Foundation Support