Shared Hemodialysis Care Practice Patterns and Their Association With Shared Decision-Making in the United Kingdom

Area of Science:

• Nephrology
• Patient Experience
• Healthcare Management

Background:

• Shared hemodialysis care (shared care) involves in-center hemodialysis patients undertaking dialysis tasks.
• While recognized for benefits, shared care data is not routinely reported, and its impact on patient experience, particularly shared decision-making, is understudied.
• Renal patients consistently report low scores for shared decision-making.

Purpose of the Study:

• To examine the variation in shared care offered across UK kidney centers.
• To assess the association between shared care and shared decision-making scores among hemodialysis patients.

Main Methods:

• Utilized data from the UK Kidney Patient Reported Experience Measure survey.
• Assessed shared care offer/acceptance via a single survey question.
• Derived shared decision-making scores from three patient-reported questions (1-7 scale) and analyzed associations using linear mixed models.

Main Results:

• Included 6861 patients; 53% were offered shared care (47% in 2022), with significant center-to-center variation (13%-93%).
• Shared care was more accessible to patients aged 31-55, ethnic minorities, and those in satellite units.
• Patients offered shared care reported significantly higher shared decision-making scores (mean increase of 0.61).

Conclusions:

• Shared care participation is growing in the UK but shows inequitable access based on patient age, ethnicity, and dialysis unit location.
• This study establishes a positive association between shared care and shared decision-making.
• Implementing shared care models can enhance shared decision-making and improve the overall patient experience in kidney care.