Decisional Regret in Adults Facing Treatment Choices for Kidney Failure: A Systematic Review

Choosing the treatment for kidney failure, whether dialysis or conservative kidney management, is challenging. Many adults may experience regret about this decision, leading to poor quality of life. This review aimed to determine the proportion of patients who report decisional regret after making treatment choices for kidney failure, as well as to identify the factors that contribute to it.

This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search was performed through the databases PubMed, Web of Science, Scopus, APA PsycInfo, and through websites. The search strategy included terms of three main categories: adults with kidney failure or estimated glomerular filtration rate less than 30 mL/min/1.73 m2, kidney failure treatment, and decisional regret.

Studies examining decisional regret in adults undergoing kidney replacement therapy, those in the pre-dialysis phase, or those receiving conservative kidney management were included. Initially, 1,712 articles were found by the reported research, and 22 of them were selected. The proportion of regret ranged from none to 62% and the factors most related to it were the lack of information, lack of patient autonomy, social and physical burden, and decisional conflict.

Decisional regret is a common experience among adults facing treatment choices for kidney failure, particularly when patient autonomy is compromised, or information is inadequate. Regret is also associated with decisional conflict, and with emotional, social and physical burden, impacting quality of life. Effective communication between healthcare professionals and patients plays a vital role in reducing decisional regret, leading to improved outcomes and greater patient satisfaction. Additionally, practical tools such decision aids can enhance shared decision-making and empower patients to make informed and autonomous choices.