Value of patient decision aids for shared decision-making in kidney failure

Abstract

Background

It is unknown how often Dutch patient decision aids are used during kidney failure treatment modality education and what their impact is on shared decision-making.

Objectives

We determined the use of Three Good Questions, ‘Overviews of options’, and Dutch Kidney Guide by kidney healthcare professionals. Also, we determined patient-experienced shared decision-making. Finally, we determined whether the experience of shared decision-making among patients changed after a training workshop for healthcare professionals.

Design

Quality improvement study.

Participants

Healthcare professionals answered questionnaires regarding education/patient decision aids. Patients with estimated glomerular filtration rate <20 mL/min/1.73 m² completed shared decision-making questionnaires. Data were analysed with one-way analysis of variance and linear regression.

Results

Of 117 healthcare professionals, 56% applied shared decision-making by discussing Three Good Questions (28%), ‘Overviews of options’ (31%–33%) and Kidney Guide (51%). Of 182 patients, 61%–85% was satisfied with their education. Of worst scoring hospitals regarding shared decision-making, only 50% used ‘Overviews of options’/Kidney Guide. Of best scoring hospitals 100% used them, needed less conversations (p = 0.05), provided information about all treatment options and more often provided information at home. After the workshop, patients' shared decision-making scores remained unchanged.

Conclusions

The use of specifically developed patient decision aids during kidney failure treatment modality education is limited. Hospitals that did use them had higher shared decision-making scores. However, the degree of shared decision-making experienced by patients remained unchanged after healthcare professionals were trained on shared decision-making and the implementation of patient decision aids.