Content of a decision analysis for treatment choice in end-stage renal disease: who should be consulted?

For an illness whose treatment options lead to similar survival, quality-of-life issues determine the choice. If the patient has not yet experienced the treatments, then the information provided regarding the options plays a crucial role in the patient's choice. The authors interviewed 43 people who are intimately involved with the treatments for end-stage renal disease (ESRD) (ten physicians, 11 nurses, and 22 patients) with a view to determining what information needs to be considered when choosing between the various treatment options for this illness. They compared the three groups based on the items obtained from the interviews to determine whether the inclusion of patients in the process changed the content of the treatment descriptions. They were also interested in determining whether the use of the frequency with which an item is mentioned in the interviews is a valid measure of its relative importance to other items. 1,269 relevant items were obtained from the interviews and categorized into 51 areas of concern (subject domains). The health professionals (physicians and nurses) were found to have mentioned seven subject domains more often than the patients, and no domain was mentioned more often by the patients than by the health professionals. The frequency that an item was mentioned was correlated (r = 0.55) with direct measures of its importance. These results imply that careful consultation with health professionals to determine the content of a decision analysis or informational materials that address treatment choice is sufficient to address patient concerns and that items can be chosen for inclusion based on the relative frequencies with which they are mentioned.