Shared decision-making in conservative care for patients with chronic kidney disease: A concept analysis

Patients with chronic kidney disease (CKD) face difficult treatment decisions, including whether to pursue conservative care or renal replacement therapy. These decisions may be even more difficult and complex for older adults with CKD. Conservative care emphasizes symptom control and quality of life for patients unlikely to benefit from dialysis, which is more likely in older adults. In this context, shared decision-making (SDM), a collaborative process between providers and patients, is essential for aligning care with patient values. We conducted a concept analysis using Walker and Avant's method to clarify the definition of SDM in conservative CKD care. A systematic literature search was performed in 2025 using five databases, and 12 studies were included. Three defining attributes of SDM emerged: (1) patient-centered dialogue emphasizing individualized goals and advanced care planning; (2) balance between autonomy and medical guidance; and (3) interdisciplinary collaboration. Three key antecedents were identified: (1) patient education to enhance understanding of disease trajectory and care options; (2) provider training in SDM and communication; and (3) systemic support. Consequences included (1) improved quality of life, as patients received goal-aligned care; (2) reduced family-provider conflict; and (3) better use of healthcare resources. Empirical referents such as the Shared Decision-Making Questionnaire were used in multiple studies to assess patients' involvement in decision-making, highlighting their utility in evaluating SDM interventions. Our findings provide a conceptual foundation for advancing SDM interventions and nephrology practice and research.