Shared Decision-Making in Dialysis Modality Selection Among Adults with Advanced Kidney Disease in Saudi Arabia: A...

Aim: Shared decision-making is increasingly recognized as a cornerstone of person-centered care. The aim of this study to assess the level of adults' involvement in shared decision-making regarding dialysis modality choice and to identify its factors. Design: A cross-sectional correlational design was used. Methods: Data were collected from adults with advanced chronic kidney disease (CKD) at two Saudi hospitals between July and December 2024. Shared decision-making was measured using the Arabic version of the 9-item Shared Decision-Making Questionnaire. Perceived health status was assessed using a single item from the Kidney Disease Quality of Life questionnaire. Education and support were assessed using two dichotomous items. Data were analyzed using descriptive statistics, t-tests, ANOVA, and multiple regression analysis. Results: A total of 294 participants were included. The mean shared decision-making score was 64.7%. The highest mean item scores were observed for clarifying that a decision was required (4.65 ± 1.861) and assisting patients in understanding the available information (4.60 ± 1.682). A multiple regression analysis examined the contributions of attendance at a kidney treatment options education class and perception of health to shared decision-making perception among participants. The final model was statistically significant, F(2, 291) = 16.60, p < 0.001, and accounted for 10.2% of the variance in shared decision-making perception (R² = 0.102, adjusted R² = 0.096). Attendance at a kidney treatment options education class was a significant positive predictor in both steps (B = 0.436, SE = 0.086, β = 0.282, p < 0.001), and perception of health contributed uniquely in the final model (B = 0.056, SE = 0.025, β = 0.127, p = 0.024). Education-class attendance exerted a stronger unique effect than perception of health. Together, these two factors explained a modest but statistically significant portion of the variance in shared decision-making perception. Conclusions: Adults with advanced CKD in Saudi Arabia reported moderate-to-high levels of perceived shared decision-making, although collaborative deliberation and joint treatment selection remained limited. Attendance at a kidney treatment options education class showed the strongest unique association with higher shared decision-making perception, followed by perceived health status. Although these factors together explained only a modest proportion of the variance, the findings underscore the value of structured education and support in promoting patient involvement in treatment decisions. Further research should evaluate whether integrating structured kidney treatment options education into pre-dialysis care pathways improves person-centered care and patient engagement in modality selection.