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Human-Centred Design & Development of a Shared Decision Aid for Patients with Chronic Kidney Disease Facing Treatment
Julie Babione1, Denise Kruger1, Pantea Javaheri1
1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
A new decision aid supports shared decision-making for coronary artery disease (CAD) in patients with chronic kidney disease (CKD). This tool facilitates informed choices between invasive and conservative CAD treatments, enhancing patient-physician collaboration.
Area of Science:
- Cardiology
- Nephrology
- Health Informatics
Background:
- Coronary artery disease (CAD) frequently co-occurs with chronic kidney disease (CKD), necessitating specialized management strategies.
- Shared decision-making (SDM) is crucial for aligning treatment choices with patient values, preferences, and risk tolerance.
- Existing management approaches for CAD in CKD patients lack adequate support for SDM regarding invasive versus conservative treatment options.
Purpose of the Study:
- To develop and evaluate a patient-centered decision aid for SDM in CAD patients with CKD.
- To provide personalized risk estimates for CAD treatment options, incorporating patient values and preferences.
- To support collaborative decision-making between patients and physicians regarding invasive vs. conservative CAD treatment.
Main Methods:
- Human-centered design principles and established frameworks (International Patient Decision Aid Standard, Ottawa Decision Support Framework) guided development.
- A mixed-methods study involved iterative evaluation of the decision aid by patients with CKD and physicians.
- Data collection included surveys for quantitative feedback and interviews for qualitative insights into design and implementation.
Main Results:
- The decision aid underwent three development iterations based on user feedback from 32 patients and 18 physicians.
- Users generally responded positively to the decision aid's content and design.
- Key themes emphasized facilitating patient-physician interaction, addressing user needs, and ensuring flexible workflow integration.
Conclusions:
- Human-centered design effectively produced a decision aid to support SDM for CAD treatment in CKD patients.
- The developed decision aid is available at https://myheartandckd.ca.
- Findings offer valuable insights for future clinical implementation of decision support tools in this population.
Background:
Coronary artery disease (CAD) commonly accompanies chronic kidney disease (CKD) and carries unique management considerations for people with CKD. Shared decision-making (SDM) is a collaborative approach in which patients and physicians make decisions together based on a shared understanding of the health condition, treatment options and attributes, patient values and preferences, and risk tolerance. Our objective was to support SDM by creating a decision aid for patients with CKD and physicians addressing invasive vs conservative CAD treatment options, which included personalized risk estimates for treatment option attributes, and identification of patient values and preferences.
Methods:
Applying human-centred design, informed by the International Patient Decision Aid Standard and Ottawa Decision Support Framework, we created a personalized shared decision aid. A concurrent mixed-methods study involved patients and physicians evaluating content, features, implementation contexts, and guided design. Survey data analysis used descriptive statistics, and interview transcripts were analyzed using deductive content analysis.
Results:
Thirty-two patients (47% aged < 65 years; 47% women) and 18 physicians (72% aged < 50 years; 22% women) evaluated successive decision-aid iterations, providing design and implementation perspectives. Most received decision-aid content positively, and the design was refined over 3 development iterations. Overarching development-informing themes were as follows: (i) facilitating patient-physician interactions and knowledge-sharing to enable SDM; (ii) responding to contextual end-user needs for decision-making; and (iii) supporting flexible workflow use and integration. The decision aid is available at: https://myheartandckd.ca.
Conclusions:
Human-centred design processes effectively guided creation of a decision aid for patients with CKD and physicians making shared CAD treatment decisions. Findings will inform future clinical implementation strategies.
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