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Japanese Patients' Perceptions of Shared Decision-Making in Renal Replacement Therapy
Yugo Shibagaki1, Tadashi Sofue2, Hiroo Kawarazaki3
1Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki-city, Kanagawa, Japan.
Kidney International Reports
|August 15, 2025
Summary
Japanese chronic kidney disease patients recognized shared decision-making (SDM) in renal replacement therapy (RRT) selection retrospectively. Improved systems for timely, repeated SDM discussions involving multidisciplinary teams are crucial.
Area of Science:
- Nephrology
- Health Services Research
- Patient-Centered Care
Background:
- Shared decision-making (SDM) is integral to selecting renal replacement therapy (RRT).
- Understanding patient perceptions and influencing factors in RRT selection is vital for effective SDM.
Purpose of the Study:
- To analyze SDM perceptions and preferences among Japanese chronic kidney disease (CKD) patients undergoing RRT selection.
- To identify patient- and facility-level factors associated with SDM perceptions.
Main Methods:
- Cross-sectional survey of 475 adult CKD patients across 49 facilities.
- Assessed SDM awareness, recognition, timing, frequency, content, and professional involvement.
- Multivariable analysis used to evaluate factors associated with SDM perceptions.
Main Results:
- 81.2% recalled SDM during RRT selection, but only 4.7% were aware of SDM beforehand.
- Patients prioritized discussions on daily life impact, finances, and family concerns.
- Multiple outpatient visits, nurse participation, and extended consultations were linked to better SDM perceptions.
Conclusions:
- Japanese CKD patients often retrospectively view RRT selection as SDM, despite limited prior awareness.
- Establishing systems for repeated, timely SDM discussions is essential.
- Discussions should focus on life impact and involve a multidisciplinary team.
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