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Shared decision making: a personal view from two kidney doctors and a patient
Barnaby Hole1,2, Miranda Scanlon1,3, Charlie Tomson1,4
1North Bristol NHS Trust, Department of Nephrology, Bristol, UK.
Clinical Kidney Journal
|September 15, 2023
Summary
Shared decision making (SDM) in kidney disease care empowers patients by integrating their values with clinical expertise. Overcoming barriers to SDM is crucial for equitable, patient-centered kidney disease management.
Area of Science:
- Nephrology
- Medical Ethics
- Health Services Research
Background:
- Shared decision making (SDM) integrates clinician expertise with patient values in healthcare.
- Implementing SDM in routine kidney disease care faces significant barriers.
- Patients often desire more involvement in their care decisions, despite historical paternalistic models.
Purpose of the Study:
- To explore the integration of shared decision making (SDM) in kidney disease care.
- To identify barriers to SDM adoption in nephrology.
- To advocate for patient-centered care models in kidney disease management.
Main Methods:
- Analysis of current practices in kidney disease consultations.
- Review of institutional and practical barriers to SDM.
- Discussion of strategies to promote patient engagement in decision-making.
Main Results:
- Nephrologists may underestimate risks and overestimate benefits, defaulting to burdensome treatments.
- A lack of patient decision aids hinders effective SDM.
- Paternalistic care models persist, with insufficient focus on consultation skills.
Conclusions:
- SDM adoption requires shifting from paternalistic to patient-centered care in nephrology.
- Addressing health inequalities necessitates providing SDM support to all patients.
- Enhanced consultation skills and patient communication are vital for successful SDM in kidney care.
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