Human-Centred Design & Development of a Shared Decision Aid for Patients with Chronic Kidney Disease Facing Treatment for Coronary Heart Disease

Abstract

Background

Coronary artery disease (CAD) commonly accompanies chronic kidney disease (CKD) and carries unique management considerations for people with CKD. Shared decision-making (SDM) is a collaborative approach in which patients and physicians make decisions together based on a shared understanding of the health condition, treatment options and attributes, patient values and preferences, and risk tolerance. Our objective was to support SDM by creating a decision aid for patients with CKD and physicians addressing invasive vs conservative CAD treatment options, which included personalized risk estimates for treatment option attributes, and identification of patient values and preferences.

Methods

Applying human-centred design, informed by the International Patient Decision Aid Standard and Ottawa Decision Support Framework, we created a personalized shared decision aid. A concurrent mixed-methods study involved patients and physicians evaluating content, features, implementation contexts, and guided design. Survey data analysis used descriptive statistics, and interview transcripts were analyzed using deductive content analysis.

Results

Thirty-two patients (47% aged < 65 years; 47% women) and 18 physicians (72% aged < 50 years; 22% women) evaluated successive decision-aid iterations, providing design and implementation perspectives. Most received decision-aid content positively, and the design was refined over 3 development iterations. Overarching development-informing themes were as follows: (i) facilitating patient-physician interactions and knowledge-sharing to enable SDM; (ii) responding to contextual end-user needs for decision-making; and (iii) supporting flexible workflow use and integration. The decision aid is available at: https://myheartandckd.ca.

Conclusions

Human-centred design processes effectively guided creation of a decision aid for patients with CKD and physicians making shared CAD treatment decisions. Findings will inform future clinical implementation strategies.