Patient Activation, Social Support, Physician Trust, and Shared Dialysis Decision-Making: A Cross-Sectional Investigation

Abstract

Rationale & Objective

People undergoing maintenance dialysis often lack essential information about kidney therapy options. Therefore, nephrologists must involve patients and families in shared decision-making (SDM). In this investigation, we hypothesized that patient activation, social support, and physician trust would be associated with patient-reported SDM.

Study Design

A cross-sectional survey.

Methods

We surveyed hospitalized individuals receiving maintenance dialysis. Participants completed the 9-item SDM questionnaire (SDM-Q-9) and the Patient Activation Measure-13, the Multidimensional scale of perceived social support, and the Primary Care Assessment Survey Trust Subscale.

Analytic Approach

We used descriptive statistics to present demographics. We included patient demographics in multivariable linear regression models predicting SDM scores.

Results

Of the 223 respondents, 222 patients completed SDM-Q-9, 54% were ≥65 years old, with 47% being woman. In addition, 37% self-identified as African American, 48% had an education level at ≤high school, and 54% reported an annual household income of ≤$20,000. The SDM-Q-9 scores (n = 222) had a mean of 57.49 (SD = 27.07), median 58 (IQR = 38-82), and ranged from 0 to 100. The mean patient activation was 53.5 ± 16.5 (min 24, max 100), social support 61.2 ± 24 (min 0, max 100), and physician trust 59.29 ± 21.6 (min 0, max 100). In separate multivariable linear regression models, higher patient activation (1-point patient activation measure increase per 0.48-unit SDM increase; 95% CI, 0.24-0.73), higher social support (1-point increase per 0.28 SDM increase; 95% CI, 0.11-0.45), and greater physician trust (0.31-point increase per 1-point SDM increase; 95% CI, 0.12-0.49) were significantly associated with greater SDM.

Limitations

The study was a cross-sectional investigation.

Conclusions

Our findings indicate a significant association between SDM and patient activation, social support, and physician trust. Future research with individuals actively considering kidney therapy options should prospectively explore the relationship between patient activation, social support, physician trust and SDM.

Plain Language Summary

There is limited literature on the association between patient activation, social support, and physician trust with patient-reported shared dialysis decision-making. Therefore, we examined this association in a convenience sample of 222 people receiving maintenance dialysis. We found that patient activation, social support, and physician trust were independently associated with shared dialysis decision-making. Future prospective studies are needed to explore the relationship between patient activation, social support, physician trust, and shared dialysis decision-making among individuals actively considering kidney therapy options.