Patient-physician communication in advanced kidney disease: a narrative review

The increasing prevalence of kidney failure highlights the crucial need for effective patient-physician communication to improve health-related quality of life and ensure adherence to treatment plans. This narrative review evaluates communication practices in the context of advanced kidney disease, focusing on the frameworks of shared decision-making, advanced care planning, and communication skills training among nephrologists. The findings highlight the significant gaps in patient-physician communication, particularly in the domains of advanced care planning, shared decision-making, and dialysis withdrawal. When communication in such situations falls short, it affects patient satisfaction and outcomes. Effective communication is essential for managing advanced kidney disease, requiring a patient-centered approach that includes patients, families, and healthcare providers in care planning. This review advocates for a more integrated, empathic approach to healthcare interactions, emphasizing the importance of including patients, their families, and healthcare providers in a collaborative model based on goals of care. Moreover, it highlights the role of patient-reported outcome measures and patient experience of care in assessing the quality of care in dialysis settings. Here, we call for enhanced training programs regarding communication skills for physicians and emphasize the need for systemic changes to foster patient-centered communication.