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Related Experiment Videos

Shared Decision-Making in CKD: Lessons From Advance Care Planning in Taiwan.

YuHsuan Olivia Wang1, Mireille Jacobson1, Pei-Yu Tsai2

  • 1Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, LA.

Kidney Medicine
|July 1, 2026
PubMed
Summary

Advance care planning (ACP) engagement in chronic kidney disease (CKD) is influenced by trust, communication, and cultural factors. Integrating ACP into nephrology care can improve shared decision-making for patients and caregivers.

Keywords:
Advance care planningTaiwanchronic kidney diseasecultural factorspatient–caregiver engagementqualitative research

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Area of Science:

  • Nephrology
  • Bioethics
  • Health Services Research

Background:

  • Advance care planning (ACP) is crucial for shared decision-making in chronic kidney disease (CKD), where patients face complex treatment choices.
  • Taiwan's high kidney failure rate and national ACP policy offer a unique setting to study ACP engagement separate from nephrology care.

Purpose of the Study:

  • To explore factors influencing advance care planning (ACP) engagement among patients with moderate-to-severe chronic kidney disease (CKD) and their caregivers in Taiwan.
  • To identify facilitators and barriers to ACP engagement within the Taiwanese healthcare system.

Main Methods:

  • An exploratory qualitative study utilizing semi-structured interviews with 9 patients with CKD (stage 3-5) and 7 caregivers.
  • Inductive thematic analysis of interview transcripts conducted in local languages, with thematic saturation achieved after 16 interviews.

Main Results:

  • Six key themes emerged: trust in nephrology care teams, patient-caregiver communication preferences, preference for in-person consultations, increased ACP engagement among transplant patients, sensitivity to service fees, and cultural hesitations.
  • Trust in the nephrology care team and communication preferences significantly influenced ACP engagement.

Conclusions:

  • Advance care planning (ACP) should be integrated into the shared decision-making continuum of CKD care.
  • Leveraging clinical milestones, embedding ACP into nephrology workflows, and ensuring financial coverage can enhance patient-centered decision-making.
  • Taiwan's experience highlights the impact of system design, clinician roles, and culture on shared decision-making in healthcare.