An Initiative to Improve Nephrology Clinician Confidence in Shared Decision Making

Shared decision making (SDM) is the preferred model for medical decision making, but implementation in kidney failure treatment decisions remains suboptimal. We educated nephrology clinicians to engage in comprehensive SDM with empathetic communication.

Single-arm educational intervention with pre-post evaluation.

Three virtual educational sessions for 80 nephrology clinicians from 14 nephrology practices in the Expanding and Promoting Alternative Care and Knowledge in Decision-Making (ExPAND) clinical trial.

We educated nephrology clinicians to operationalize SDM, including presentation of active medical care without dialysis, using the Ask-Tell-Ask approach and empathetic communication.

Participants rated their pre- and postsession confidence in achieving the learning objectives and provided qualitative feedback.

We used the Wilcoxon signed-rank paired test and obtained effect sizes (Cohen's r) to compare pre-post ratings.

On a 7-point scale, median postsession confidence ratings increased 1 to 2 points from presession ratings for all learning objectives. The effect sizes (Cohen's r) for the increase were large for 12 of the 13 objectives. The 2 objectives showing the greatest improvement were using the 9 elements of SDM (2.00; 95% CI, 1.50-3.00; P < 0.001, r = 0.84) and delivering kidney disease education with a balanced presentation of all the options including active medical care without dialysis (2.00; 95% CI, 1.50-3.00; P < 0.001, r = 0.75). The qualitative feedback supported the quantitative results.

Participant perceptions may not be generalizable to all nephrology clinicians. We did not measure whether improvements were retained over time or applied in practice.

The increase in clinician confidence suggests that our explicit instruction on how to conduct comprehensive SDM with empathetic communication may represent a breakthrough in improving the quality of SDM in the care of older patients with chronic kidney disease and kidney failure.