Training Nurses to Support Renal Replacement Therapy Decision-Making Using the Three-Talk Model.

 Starting in 2024, in Japan, reimbursement became possible for providing explanations and consultations regarding renal replacement therapy to patients with kidney disease (up to two sessions per patient). While Fussa Hospital has long operated its own renal replacement therapy decision support system, specific training for nurses had not been conducted. It is considered important for nurses providing decision support to acquire communication skills that enable them to stay close to patients and help them express their feelings. It is desirable for them to develop these skills through conversation exercises based on frameworks such as Three-talk model (Elwyn et al, 2017). To study the practical application for a decision-making support program for renal replacement therapy selection by trained nurses at Fussa Hospital, with the aim of establishing a system that enables patients with chronic kidney disease to make their own therapy choices together with their families. To assess the self-efficacy of nurses involved in renal replacement therapy decision support for patients with chronic kidney disease regarding decision support.

 Improve the decision support system for patients with chronic kidney disease based on the recommendations of the Japanese Society for Dialysis Medicine (2020). The role of the healthcare team was clarified and training on chronic disease nursing, including education on renal replacement therapy and training on chronic disease nursing were provided to nurses who clarify the role of the health care team and provide decision support. These nursing education programs were conducted in three parts: ① Renal Replacement Therapy ② About Shared Decision Making：SDM, Three-Talk Model ③ Chronic Illness Nursing Following implementation, tests and exercises were conducted to ensure participants achieved a certain level of proficiency. This aimed to help nurses view chronic kidney disease patients as daily life person. Additional training was provided to nurses who expressed concerns about assessments even after completing training.

Five nurses agreed to participate in the study. The educational program included multiple training sessions:①8times ②４times ③４times. In the post-training survey, participants responded with the following: "I learned about SDM for the first time. It seems difficult to listen to the other person's values." "I learned the SDM model and would like to use it for patients other than CKD patients." "I have concerns about physical assessment." The "personality trait self-efficacy (SMSGSE)" of the nurses involved in the RRT decision support did not change, while the researcher-generated "domain-specific self-efficacy (SSE)" increased significantly after implementation. Gradually, their anxiety about performing physical assessments on patients diminished, and they became able to listen to their concerns. It led to the revision of the program.

 A new collaborative renal replacement therapy decision-making program for patients with chronic kidney disease at Fussa Hospital increased nurses' domain-specific self-efficacy, but challenges remained regarding how to communicate with patients. Decision-making conflict was also elevated in patients who reached a decision. This was thought to be due to patients entering an uncertainty lifestyle with renal replacement therapy.