The following is the summary of “Shared Decision Making Among Older Adults With Advanced CKD” published in the November 2022 issue of Kidney Diseases by Frazier, et al.
Choices about starting dialysis might be challenging for elderly patients with advanced chronic kidney disease (CKD). The extent to which older patients with CKD engage in shared decision making (SDM), which can help align patient preferences and values with treatment options, is uncertain. Decision-readiness, education on treatment alternatives, care partner support, and shared decision-making are all examined in this cross-sectional study of patient surveys. Those who are 70 and above and living in Boston, Chicago, San Diego, or Portland (Maine) have advanced CKD that is being managed without dialysis. Preparation for making decisions, familiarity with available treatments, and assistance from a trusted caretaker.
Specifically, Shared Decision Making (SDM) measured by the Shared Decision Making Questionnaire (SDM-Q-9), with higher scores indicating higher SDM. Factors linked to SDM; a preliminary investigation. With the help of multivariable linear regression models, researchers analyzed the connections between SDM and predictors while taking into account both individual and contextual characteristics. The average age of the 350 people who took part was 78 ±6 years; 58% were men, 13% were Black, and 48% had diabetes. The mean score on the SDM-Q-9 was 52 ±28. From “their doctor and they selected a treatment option together” (41% of participants agreed) to “their doctor told them that there are numerous alternatives for treating my medical condition” (73% of participants agreed), the range of agreement on SDM items was wide.
Being “well informed” or “very well informed” about kidney treatment options, having higher decisional certainty, and attending a class on kidney treatment options were independently associated with higher SDM-Q-9 scores in multivariable analysis after controlling for demographic characteristics, lower estimated glomerular filtration rate, and diabetes. There is a restriction on drawing temporal relationships between SDM and the variables due to the cross-sectional study design. There is a pressing need to improve the availability and accessibility of information for people with severe CKD because many elderly patients may not suffer SDM when deciding whether or not to begin dialysis.