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042 Decision support interventions for dialysis choice: a structured process of shared decision making for a patient with chronic kidney disease. A case study
  1. Katherine Cherry1,
  2. Dawn Stacey2,
  3. Jeanette Finderup3
  1. 1Department of Nephrology, Austin Health, Melbourne, Australia
  2. 2Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada
  3. 3Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark

Abstract

Introduction Patients with chronic kidney disease (CKD) face the difficult decision about choosing type of dialysis. The purpose of this case study was to explore the use of a decision support intervention provided by a nurse recently trained in decision coaching.

Methods A case study was conducted guided by the Ottawa Decision Support Framework. The eligible participant had to be experiencing decisional conflict about choosing dialysis modality. The nurse trained in decision coaching assessed the participant’s decisional needs, provided decision coaching using the Ottawa Personal Decision Guide, and screened for decisional conflict using a 4-item SURE Test. Descriptive analysis was used to measure change in decisional needs and quality of decision coaching using the Decision Support Analysis Tool (DSAT).

Results An 81 yr. with stage 5 CKD showed uncertainty regarding his dialysis choices (home haemodialysis, centre haemodialysis, peritoneal dialysis). He previously received standardized education and discussions at medical appointments. After decision coaching (51 minutes), he scored 4 on 4 for the SURE Test. He reported feeling supported by his family and no pressure to choose an option. The patient was satisfied with decision coaching. The nurse scored 8 on 10 for the DSAT (lost points regarding the initial identification of uncertainty and intervening about potential harms).

Discussion Decision coaching by an experienced CKD nurse, newly trained in decision coaching helped resolve decisional needs and the patient reported a positive experience. The nurse should enhance her skills in clearly initiating the decision coaching and confidence intervening regarding potential harms of treatments. This intervention fit within the Australian CKD healthcare context.

Conclusion A structured approach can be used to assist CKD patients making dialysis choices based on what matters most to them. Decision coaching with a trained CKD nurse should be evaluated as part of the CKD model of care.

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