SHARED DECISION-MAKING AMONG JAPANESE INCIDENT DIALYSIS PATIENTS AND NEPHROLOGISTS

whereas 97% of patients receive hemodialysis. Although interest in SDM is growing, it is possible that SDM is not being fully practiced when selecting renal replacement therapies. The present study aims to clarify the state of shared decision-making among physicians and patients who initiated dialysis. 

Methods:

This study was a cross-sectional survey of Japanese incident dialysis patients who started dialysis in 2022.  The survey questionnaire was sent to physicians and incident dialysis patients at 376 facilities that had more than 20 incident dialysis patients and at least one incident peritoneal dialysis patient in 2022.  The questionnaire included the Japanese version of the 9-item SDM questionnaire for patients (SDM-Q-9), physicians (SDM-Q-Doc), and the Decisional Conflict Scale (DCS). The survey also included questions examining the perceptions of both patients and physicians regarding explanations about dialysis modalities. Patients were asked, "Have you received an explanation about dialysis therapy?" while doctors were asked, "Have you explained dialysis therapy?"

Results:

Data were analyzed for 308 dialysis patients with a mean age of 67.8 years, 69.7% were male, and 24.0% of patients selected PD. A hundred-six nephrologists with a mean age of 45.7 years completed the survey. Regarding whether information about peritoneal dialysis was provided, 99.1 percent of physicians responded that they explained PD to patients. In contrast, only 79.1% of patients responded that their physician explained about peritoneal dialysis. Strikingly, 37 % (87/234) of those who selected HD perceived they did not receive information about PD, while only 1.4% (1/74) of PD patients did so. The proportion of patients who answered that they received an explanation about PD was significantly higher among those who chose PD compared to those who chose HD (98.6 vs 62.8%; p<0.001). Physicians rated higher SDM-Q score than patients (83.5 vs 74.4; p<0.001). This is prominent in SDM-Q item 4,5 and 8 (Figure). PD patients rated higher SDM-Q score than HD patients (mean 78.4 vs 73.1; p=0.045). DCS is lower in PD patients than HD patients (26.9 vs 31.9; p=0.039).  A strong association was observed between SDM-Q-9 and DCS, reflecting that the practice of SDM decreases decisional conflict (p<0.001).

Conclusions:

A great gap exists in SDM and the perception of dialysis modality selection discussion between patients and physicians. Although a majority of physician considers that they explained about PD, 29% of the patients perceived that they did not receive information about various treatment options. SDM-Q-9 is higher, and DCS is lower among PD patients, suggesting that well-informed patients, through shared decision-making, facilitates the dissemination of PD.

I have potential conflict of interest to disclose.
This study is supported by a research grant from Baxter.

I did not use generative AI and AI-assisted technologies in the writing process.