ESRD treatment modality selection: which factors are important in the decision?

Area of Science:

• Nephrology
• Medical Decision Making
• Patient Care

Background:

• Choosing between treatments for end-stage renal disease (ESRD) involves complex factors.
• Understanding the perspectives of patients, nurses (R.N.s), and physicians (M.D.s) is crucial for effective shared decision-making.

Purpose of the Study:

• To identify the most significant factors influencing the choice between ESRD treatments.
• To evaluate agreement and disagreement among patients, R.N.s, and M.D.s regarding the importance of these factors.

Main Methods:

• Interviews were conducted with 22 patients, 11 R.N.s, and 10 M.D.s to identify 43 relevant factors for Continuous Ambulatory Peritoneal Dialysis (CAPD) and hemodialysis.
• A subsequent rating exercise involved 14 patients, 8 R.N.s, and M.D.s who scored 43 factors on a 1-10 importance scale.
• Factors were ranked based on average scores to determine their relative importance in treatment selection.

Main Results:

• Peritonitis was identified as the most important factor influencing the choice of ESRD treatment modality.
• Lifestyle considerations generally received higher importance ratings than the medical consequences of specific therapies.
• While some concordance existed, notable differences in factor importance were observed between patients, R.N.s, and M.D.s.

Conclusions:

• The findings suggest that patient counseling regarding ESRD treatment options may need improvement due to differing perspectives among stakeholders.
• Recognizing the varied importance placed on lifestyle versus medical factors is essential for optimizing patient education and treatment adherence.
• Addressing the identified discrepancies can lead to more patient-centered and effective ESRD care planning.