Shared decision-making for kidney replacement therapy: a comprehensive review and a proposed model

Area of Science:

• Nephrology
• Health Services Research
• Patient-Centered Care

Background:

• Shared decision-making (SDM) is crucial for aligning patient preferences with healthcare choices.
• Its application in selecting kidney replacement therapy (KRT) for chronic kidney disease (CKD) is gaining recognition.
• Existing SDM models require adaptation for the complexities of KRT selection.

Purpose of the Study:

• To review the concept of SDM and its global application in KRT selection.
• To identify the benefits and challenges of implementing SDM in KRT.
• To propose a novel, tailored six-step SDM framework for KRT.

Main Methods:

• Literature review of general SDM concepts and global clinical studies on SDM in KRT.
• Analysis of reported benefits (e.g., patient knowledge, satisfaction, autonomy, PD rates) and implementation challenges (e.g., time, incentives).
• Adaptation of established SDM frameworks (e.g., Clayman's model) to create a KRT-specific model.

Main Results:

• SDM in KRT enhances patient knowledge, satisfaction, and autonomy.
• Increased selection of peritoneal dialysis (PD) and potential cost savings were observed.
• Key implementation barriers include time constraints, dynamic patient needs, and insufficient incentives.

Conclusions:

• SDM significantly benefits patients undergoing KRT selection.
• A tailored six-step SDM framework is proposed to improve implementation and adoption.
• Further research is needed to validate long-term impacts and optimize SDM models for clinical practice.