Shared decision making and patient involvement in choosing home therapies

Patient involvement through shared decision making is advocated to support patients deciding on a dialysis treatment suitable to their clinical condition, lifestyle and social circumstances. Evidence to date, however, suggests that shared decision making is far from routine practice. Not all physicians or patients are willing to participate in shared decision making. Equally, modality education does not always meet the needs of patients and their families, resulting in a significant proportion of patients remaining unaware of the existence of home therapies. The selection of home therapies appears to be tightly associated with the quality of the modality education. This paper considers several ways in which patient involvement in their dialysis modality decision can be improved, with particular reference to information provision. Information needs to be balanced, explore the medical as well as the psychosocial aspects of each treatment, be tailored to the needs of the individual patient and be delivered in a timely fashion.

Optimising modality education will optimise patient's ability to participate in shared decision making, thereby improving uptake of home therapies.