Photo Credit: Richard Villalon

Researchers used feedback from patient focus groups to develop tools and recommendations for shared anticoagulant decision-making in CKD.

“People with chronic kidney disease are at increased risk for thrombotic and bleeding episodes, making anticoagulant treatment decisions challenging,” the researchers wrote in BMC Nephrology. “Currently, there are no support tools for people with chronic kidney disease regarding anticoagulant therapy decisions.”

Kathrine Parker, PhD, and colleagues conducted a study using the principles of co-production to allow patients with chronic kidney disease (CKD) taking anticoagulants to discuss their experiences. The researchers aimed to create materials to support shared decision-making for anticoagulant use in CKD.

Study participants took part in two focus groups, and data was thematically analyzed based on Makoul and Clayman’s model of SDM. Co-production methods were used to develop questions based on themes from the focus groups.

Identifying SDM Themes in Focus Groups  

Dr. Parker and colleagues identified all the themes in Makoul and Clayman’s model of SDM, including:

• Explanation of the problem
• Presentation of treatment options and monitoring
• Risks and benefits
• Factors affecting the risks of treatment
• Clinician recommendations
• Check understanding or defer follow-up
• Patient preferences
• Arrange follow-up

Questions Outlined for Patients & Clinicians

The researchers then developed, in collaboration with patients, a list of prompts based on these themes. Questions for each theme were based upon the patient’s experiences with various stages of SDM in the context of anticoagulant use in advanced CKD. Dr. Parker and colleagues noted that individualized discussion around treatment risks and follow-up arrangements were important to patients.

Questions in the final prompt list included:

• “Why am I taking an anticoagulant?”
• “What kinds of anticoagulants can be prescribed to me?”
• “When do I need to seek medical attention?”

Additionally, a set of recommendations was developed for clinicians. The recommendations included:

• Asking patients if they would like a family member involved in discussions
• Identifying if, based on the patient’s needs, they want to be involved in the decision or prefer if the decision was made by the clinician
• Discussing, for patients on warfarin, potential locations where they could go for monitoring
• Explaining who will follow up on treatment and ways to contact them

“This work provides a question prompt list, co-produced with patients, that could be used as part of shared decision-making for initiation of anticoagulants in people with kidney disease, alongside a set of recommendations for prescribers,” Dr. Parker and colleagues wrote. “These recommendations have implications for all health professionals involved in the care of people with kidney disease and are derived from the themes of the focus groups and based upon SDM recommendations.”