Photo Credit: Nadiia Lapshynska
The following is a summary of “Decision-Making Engagement Preferences among Older Adults with CKD,” published in the March 2024 issue of Nephrology by Gonzales et al.
Older adults with kidney failure often need to decide about starting dialysis. Many do not get to share in these decisions, which doctors find tricky due to uncertainty about how involved older patients want to be.
Researchers conducted a prospective study to understand how older patients prefer to be involved in dialysis initiation, aiming to improve shared decision-making in this population.
They used a mixed-method study across four centers (2018 to 2020) to examine decision-making preferences among patients fluent in English, aged ≥70 years with CKD stages 4-5. The Control Preference Scale (CPS) assessed patient engagement preferences. It classified the participants as follows: active (Patients making the final decisions), Collaborative (patients sharing decision-making with clinicians), or passive (clinicians making the final decisions). Engagement and decision-making were conducted in two interviews with purposely sampled patients and clinicians.
The results showed that among 363 participants (mean age: 78 ± 6 years, 42% female, 21% with ≤ high school education), 48% preferred active, 43% collaborative, and 8% passive engagement. Preferences remained stable at the three-month follow-up. From 76 interviews (45 patients, 31 clinicians), 4 themes emerged: decisional engagement levels, clinician-controlled information flow, adapting clinical approach, and clinician responsiveness supporting satisfaction with shared decision-making.
Investigators concluded that most older adults with advanced CKD preferred a collaborative or active role in decision-making. Appropriately matched information flow with patient preferences was critical for satisfaction with shared decision-making.
Source: journals.lww.com/jasn/abstract/9900/decision_making_engagement_preferences_among_older.271.aspx