Abstract: FR-PO1084
Examining KRT Decision Quality Through Extant Decisional Tools
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Vyas, Anushka, University of Florida, Gainesville, Florida, United States
- Kindel, Nicole, University of Florida, Gainesville, Florida, United States
- Parmar, Cydney El Cid, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Lin, Tuo, University of Florida, Gainesville, Florida, United States
- Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
- Freytes, I. Magaly, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background
Prior studies have used several validated tools focusing on shared decision-making (SDM), decisional conflict (DCS), or decisional confidence to examine KRT decisional state; however, we lack consensus on their value in assessing overall decisional quality. We compared extant decision evaluation methods against individuals' KRT decisional state to identify a clinically usable measure.
Methods
This evaluation was conducted as a sub-study to the ongoing multi-site, ALIGN for Kidney Failure Care, a prospective cohort study. We enrolled 130 Veterans with advanced CKD across six states and evaluated their KRT decisional state using the following prior-validated decisional quality tools: SDM through SDM-Q9, DCS through SURE scale, and parsimonious confidence in KRT selection through a Likert Scale, treating >60% confidence as a discriminatory benchmark for KRT selection. Outcome measures were 1) ability to select KRT and 2) home dialysis choice. Area under the receiver operating curve (AUC) was calculated for each tool against the study outcomes, and correlations were examined across the tools.
Results
Moderate-strength (r = 0.40-0.58) correlations were observed across different tool scores. The correlation between SDM-Q9 and SURE was the highest (r = 0.58), and the correlation between SDM-Q9 and the confidence scale with the >60% benchmark was the weakest (r = 0.40). The confidence in KRT selection scale had AUC of 0.98 and 0.78 for any KRT and home dialysis selection; the corresponding values of AUC for SDM-Q9 were 0.71 and 0.67, SURE were 0.80 and 0.64.
Conclusion
Extant tools, i.e., SDM-Q9 and SURE scales, used in KRT decisional quality appear adequate for the research purposes but have fair to moderate discriminatory capacities, limiting their routine clinical application. Using confidence in KRT selection through Likert as a discriminatory benchmark for KRT selection may allow clinicians to have a clinically usable and parsimonious measure to guide KRT decision-directed care.
Funding
- Veterans Affairs Support