Shared decision-making in chronic kidney disease: A retrospection of recently initiated dialysis patients in Germany.

Abstract

OBJECTIVE: To compare differences in shared decision-making (SDM) and treatment satisfaction (TS) between haemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: 6-24 months after initiation of dialysis, we surveyed 780 patients from throughout Germany (CORETH-project) regarding SDM, the reason for modality choice and TS. Data were compared between two age-, comorbidity-, education-, and employment status-matched groups (n=482). RESULTS: PD patients rated all aspects of SDM more positively than did HD patients (total score: MPD=84.6, SD=24.1 vs. MHD=61.9, SD=37.3; p≤0.0001). The highest difference occurred for the item "announcement of a necessary decision" (delta=1.3 points on a 6-point Likert-scale). PD patients indicated their desire for independence as a motivator for choosing PD (65%), whereas HD patients were subject to medical decisions (23%) or wanted to rely on medical support (20%). We found positive correlations between SDM and TS (0.16≤r≤0.48; p≤0.0001). CONCLUSION: Our findings increase awareness of a participatory nephrological counseling-culture and imply that SDM can pave the way for quality of life and treatment success for dialysis patients. PRACTICE IMPLICATIONS: Practitioners can facilitate SDM by screening patient preferences at an early stage, being aware of biases in consultation, using easy terminology and encouraging passive patients to participate in the choice.