Perceived Shared Decision-Making during Maintenance Hemodialysis: Associations with Health Literacy, Social...

Shared decision-making (SDM) is a core component of patient-centered care. In chronic kidney disease, SDM research has largely focused on dialysis modality choice, with limited attention to routine clinical decisions during maintenance hemodialysis. We assessed patients' perceived SDM during routine hemodialysis care and examined individual and contextual factors associated with perceived SDM.

A multicenter, cross-sectional, observational study was conducted among adult patients receiving maintenance hemodialysis at the Calydial dialysis network in the Rhône-Alpes region, France. Data were collected during routine dialysis sessions over a two-week period from June 24 to July 6, 2024. Independent variables included individual characteristics (age, sex, education, health literacy), socioeconomic deprivation (European Deprivation Index), dialysis autonomy, dialysis unit type, and decision characteristics. Perceived SDM was assessed using the 9-item SDM Questionnaire (SDM-Q-9). Univariable analyses and multivariable linear regression were performed to identify factors associated with SDM-Q-9 scores.

Among 104 participants (75% male; 88% aged >50 years; 64% retired), the mean SDM-Q-9 score (0 to 100 scale) was 24.3±26.1 (median 13.3), indicating low perceived SDM. Most reported decisions concerned dialysis management (57%), followed by medication-related decisions (26%) and comorbidity management (17%). In multivariable linear regression analysis, higher communicative (β=2.48; 95%CI 0.89 to 4.07; P=0.003) and critical health literacy (β=3.01; 95%CI 1.12 to 4.90; P=0.002) were associated with higher SDM-Q-9 scores, whereas greater socioeconomic deprivation was associated with lower scores (β = -1.12; 95%CI -2.05 to -0.19; P=0.02). Dialysis unit type, dialysis autonomy, and employment status were also associated with SDM-Q-9 scores.

Perceived SDM during routine hemodialysis care was generally low and heterogeneous. Health literacy, socioeconomic deprivation, dialysis autonomy, and care setting were associated with perceived SDM. Dialysis vintage was not recorded and not included in the analyses. Interventions addressing health literacy-sensitive communication and organizational factors may improve patient-centered decision-making in hemodialysis care.