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Shared Decision Making Among Older Adults With Advanced CKD.
Rebecca Frazier1, Sarah Levine2, Thalia Porteny3
1Division of Nephrology and Hypertension, Department of Medicine, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Chicago, Illinois; Jesse Brown Veterans Administration Medical Center, Chicago, Illinois.
Summary
Many older adults with advanced chronic kidney disease (CKD) do not experience shared decision making (SDM) when deciding on dialysis. Improved education and decisional support are crucial for this population.
Area of Science:
- Nephrology
- Geriatrics
- Health Services Research
Background:
- Older adults with advanced chronic kidney disease (CKD) face critical decisions regarding dialysis initiation.
- Shared decision making (SDM) is vital for aligning patient values with treatment options, but its prevalence in older CKD patients is unclear.
Purpose of the Study:
- To investigate the extent of SDM experienced by older adults with advanced, non-dialysis CKD.
- To identify factors associated with SDM in this patient group.
Main Methods:
- Cross-sectional analysis of patient surveys from 350 adults aged 70+ with advanced CKD.
- Utilized the 9-item Shared Decision Making Questionnaire (SDM-Q-9) to measure SDM.
- Employed multivariable linear regression to assess associations between SDM and predictors like decisional readiness and education.
Main Results:
- The average SDM-Q-9 score was 52 ± 28, indicating limited SDM.
- Only 41% of participants felt they selected a treatment option jointly with their doctor.
- Being well-informed about treatment options, decisional certainty, and attending educational classes were linked to higher SDM scores.
Conclusions:
- A significant proportion of older adults with advanced CKD do not experience SDM in dialysis decisions.
- Enhanced access to and delivery of kidney treatment options education are essential.
- Interventions to improve decisional readiness and support are needed for this vulnerable population.
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