Shared Decision-Making in Chronic Kidney Disease: Enhancing Patient Engagement and Reducing Pre-Dialysis Anxiety through Digital Decision Aids

Taiwan bears one of the highest global burdens of end-stage renal disease (ESRD), with an incidence of 536 per million population in 2022. Patients with chronic kidney disease (CKD) who progress to ESRD must make critical decisions regarding renal replacement therapy (RRT), including hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation, or palliative care. Such decisions profoundly impact quality of life and clinical outcomes, and are often associated with anxiety and limited understanding. Shared decision-making (SDM), supported by patient decision aids (PDA) and digital platforms, helps patients better understand treatment options and make informed, value-concordant choices.

Since 2021, our hospital has promoted the SDM program and integrated it into the REDCap system to digitalize the SDM process, incorporating renal replacement therapy (RRT) educational videos and outcome evaluation forms, and establishing a patient-centered structure supported by multidisciplinary care. Healthcare providers can initiate SDM in real time and generate patient-specific QR codes. Patients and families can then access the system at home via mobile devices without restriction, allowing them to review educational videos and electronic materials anytime, thereby improving accessibility and convenience. A back-end patient database was developed to collect and analyze execution rates, provider documentation, use of decision aids, outcome evaluations, patient feedback, and satisfaction, serving as the foundation for continuous quality improvement.

Since 2021, our hospital has continuously promoted the SDM program, with the number of activations increasing annually (from 362 to 751), indicating gradual expansion in clinical practice. Provider documentation has remained stable at 82–90%, reflecting the normalization of SDM. Although patient participation and evaluation completion rates slightly declined with increased enrollment, overall evaluation scores consistently remained between 77–82%, reaching 82% in early 2025, demonstrating sustained patient satisfaction and positive program impact. From July 2024 to June 2025, a total of 616 stage 5 CKD patients were enrolled in SDM, of whom 81.5% completed documentation, about 44% used patient decision aids, and 43% completed outcome evaluations with an average score of 81%. Among 262 patients assessed before and after SDM, anxiety scores significantly decreased (3.79→3.19, p < 0.05). Regarding treatment choices, the proportion opting for peritoneal dialysis (PD) increased from 9.7% to 14.4%, while hemodialysis (HD) decreased from 14.3% to 9.6%. In Pre-ESRD patients, 92.8% completed vascular access or PD catheter placement before dialysis initiation, significantly reducing the use of temporary catheters. Overall, SDM effectively enhanced patient engagement and preparedness, reduced anxiety, and encouraged more patients to choose PD, thereby further improving the quality of care.

RRT selection is a complex decision-making process. Our hospital’s SDM program, integrating digital decision aids with multidisciplinary care, has gradually become routine in clinical practice and achieved stable outcomes. SDM reduced pre-dialysis anxiety, improved engagement and preparedness, and increased PD uptake, thereby enhancing care quality and autonomy. Through REDCap and QR code applications, SDM improved accessibility and established a foundation for continuous quality improvement. This cost-effective and scalable model may serve as a valuable reference for multi-center collaboration and the advancement of international CKD care.