Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD
Choosing from multiple kidney failure treatment modalities can create decisional conflict, but little is known about this experience before decision implementation. We explored decisional conflict about treatment for kidney failure and its associated patient characteristics in the context of advance...
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| Veröffentlicht in: | Kidney medicine 2022-09, Vol.4 (9), p.100521, Article 100521 |
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| creator | DePasquale, Nicole Green, Jamie A. Ephraim, Patti L. Morton, Sarah Peskoe, Sarah B. Davenport, Clemontina A. Mohottige, Dinushika McElroy, Lisa Strigo, Tara S. Hill-Briggs, Felicia Browne, Teri Wilson, Jonathan Lewis-Boyer, LaPricia Cabacungan, Ashley N. Boulware, L. Ebony |
| description | Choosing from multiple kidney failure treatment modalities can create decisional conflict, but little is known about this experience before decision implementation. We explored decisional conflict about treatment for kidney failure and its associated patient characteristics in the context of advanced chronic kidney disease (CKD).
Cross-sectional study.
Adults (N = 427) who had advanced CKD, received nephrology care in Pennsylvania-based clinics, and had no history of dialysis or transplantation.
Participants’ sociodemographic, physical health, nephrology care/knowledge, and psychosocial characteristics.
Participants’ results on the Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) screening test for decisional conflict (no decisional conflict vs decisional conflict).
We used multivariable logistic regression to quantify associations between aforementioned participant characteristics and decisional conflict. We repeated analyses among a subgroup of participants at highest risk of kidney failure within 2 years.
Most (76%) participants reported treatment-related decisional conflict. Participant characteristics associated with lower odds of decisional conflict included complete satisfaction with patient–kidney team treatment discussions (OR, 0.16; 95% CI, 0.03-0.88; P = 0.04), attendance of treatment education classes (OR, 0.38; 95% CI, 0.16-0.90; P = 0.03), and greater treatment-related decision self-efficacy (OR, 0.97; 95% CI, 0.94-0.99; P < 0.01). Sensitivity analyses showed a similarly high prevalence of decisional conflict (73%) and again demonstrated associations of class attendance (OR, 0.26; 95% CI, 0.07-0.96; P = 0.04) and decision self-efficacy (OR, 0.95; 95% CI, 0.91-0.99; P = 0.03) with decisional conflict.
Single-health system study.
Decisional conflict was highly prevalent regardless of CKD progression risk. Findings suggest efforts to reduce decisional conflict should focus on minimizing the mismatch between clinical practice guidelines and patient-reported engagement in treatment preparation, facilitating patient–kidney team treatment discussions, and developing treatment education programs and decision support interventions that incorporate decision self-efficacy–enhancing strategies.
[Display omitted] |
| doi_str_mv | 10.1016/j.xkme.2022.100521 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9449857</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S2590059522001431</els_id><sourcerecordid>2713306047</sourcerecordid><originalsourceid>FETCH-LOGICAL-c455t-e87bdd9574fa3d4268ba5c0aa6e6a67d061fc9472792b6ed74fbae264535081e3</originalsourceid><addsrcrecordid>eNp9kc9rFDEUx4MottT-Az1Ijl52TTL5sQMiLNtWpS29VLwUQiZ502bNTGqSWex_b4atpV485ZF83jeP90HohJIlJVR-3C5__xxgyQhj9YIIRl-hQyZasiCiFa9f1AfoOOctIZXkUlL-Fh00krREKXaIbk_B-uzjaALexLEP3ha87uJU8IV3Izzic-PDlADfJDBlgLHgq-hM8MVDxushjnd47aZQMv7hy32td2a04PDm4vQdetObkOH46TxC38_PbjZfF5fXX75t1pcLy4UoC1ipzrlWKN6bxnEmV50RlhgjQRqpHJG0ty1XTLWsk-Aq1xlgkotGkBWF5gh93uc-TN0AztYhkwn6IfnBpEcdjdf_voz-Xt_FnW45b1dC1YAPTwEp_pogFz34bCEEM0KcsmaKNg2RhM8o26M2xZwT9M_fUKJnM3qrZzN6NqP3ZmrT-5cDPrf89VCBT3sA6pp2HpLO1sO8R5_AFu2i_1_-H_pjoAI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2713306047</pqid></control><display><type>article</type><title>Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD</title><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>DePasquale, Nicole ; Green, Jamie A. ; Ephraim, Patti L. ; Morton, Sarah ; Peskoe, Sarah B. ; Davenport, Clemontina A. ; Mohottige, Dinushika ; McElroy, Lisa ; Strigo, Tara S. ; Hill-Briggs, Felicia ; Browne, Teri ; Wilson, Jonathan ; Lewis-Boyer, LaPricia ; Cabacungan, Ashley N. ; Boulware, L. Ebony</creator><creatorcontrib>DePasquale, Nicole ; Green, Jamie A. ; Ephraim, Patti L. ; Morton, Sarah ; Peskoe, Sarah B. ; Davenport, Clemontina A. ; Mohottige, Dinushika ; McElroy, Lisa ; Strigo, Tara S. ; Hill-Briggs, Felicia ; Browne, Teri ; Wilson, Jonathan ; Lewis-Boyer, LaPricia ; Cabacungan, Ashley N. ; Boulware, L. Ebony</creatorcontrib><description>Choosing from multiple kidney failure treatment modalities can create decisional conflict, but little is known about this experience before decision implementation. We explored decisional conflict about treatment for kidney failure and its associated patient characteristics in the context of advanced chronic kidney disease (CKD).
Cross-sectional study.
Adults (N = 427) who had advanced CKD, received nephrology care in Pennsylvania-based clinics, and had no history of dialysis or transplantation.
Participants’ sociodemographic, physical health, nephrology care/knowledge, and psychosocial characteristics.
Participants’ results on the Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) screening test for decisional conflict (no decisional conflict vs decisional conflict).
We used multivariable logistic regression to quantify associations between aforementioned participant characteristics and decisional conflict. We repeated analyses among a subgroup of participants at highest risk of kidney failure within 2 years.
Most (76%) participants reported treatment-related decisional conflict. Participant characteristics associated with lower odds of decisional conflict included complete satisfaction with patient–kidney team treatment discussions (OR, 0.16; 95% CI, 0.03-0.88; P = 0.04), attendance of treatment education classes (OR, 0.38; 95% CI, 0.16-0.90; P = 0.03), and greater treatment-related decision self-efficacy (OR, 0.97; 95% CI, 0.94-0.99; P < 0.01). Sensitivity analyses showed a similarly high prevalence of decisional conflict (73%) and again demonstrated associations of class attendance (OR, 0.26; 95% CI, 0.07-0.96; P = 0.04) and decision self-efficacy (OR, 0.95; 95% CI, 0.91-0.99; P = 0.03) with decisional conflict.
Single-health system study.
Decisional conflict was highly prevalent regardless of CKD progression risk. Findings suggest efforts to reduce decisional conflict should focus on minimizing the mismatch between clinical practice guidelines and patient-reported engagement in treatment preparation, facilitating patient–kidney team treatment discussions, and developing treatment education programs and decision support interventions that incorporate decision self-efficacy–enhancing strategies.
[Display omitted]</description><identifier>ISSN: 2590-0595</identifier><identifier>EISSN: 2590-0595</identifier><identifier>DOI: 10.1016/j.xkme.2022.100521</identifier><identifier>PMID: 36090772</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Chronic kidney disease ; decisional conflict ; dialysis ; Original Research ; transplant ; treatment decision-making</subject><ispartof>Kidney medicine, 2022-09, Vol.4 (9), p.100521, Article 100521</ispartof><rights>2022 The Authors</rights><rights>2022 The Authors.</rights><rights>2022 The Authors 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c455t-e87bdd9574fa3d4268ba5c0aa6e6a67d061fc9472792b6ed74fbae264535081e3</citedby><cites>FETCH-LOGICAL-c455t-e87bdd9574fa3d4268ba5c0aa6e6a67d061fc9472792b6ed74fbae264535081e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449857/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449857/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36090772$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DePasquale, Nicole</creatorcontrib><creatorcontrib>Green, Jamie A.</creatorcontrib><creatorcontrib>Ephraim, Patti L.</creatorcontrib><creatorcontrib>Morton, Sarah</creatorcontrib><creatorcontrib>Peskoe, Sarah B.</creatorcontrib><creatorcontrib>Davenport, Clemontina A.</creatorcontrib><creatorcontrib>Mohottige, Dinushika</creatorcontrib><creatorcontrib>McElroy, Lisa</creatorcontrib><creatorcontrib>Strigo, Tara S.</creatorcontrib><creatorcontrib>Hill-Briggs, Felicia</creatorcontrib><creatorcontrib>Browne, Teri</creatorcontrib><creatorcontrib>Wilson, Jonathan</creatorcontrib><creatorcontrib>Lewis-Boyer, LaPricia</creatorcontrib><creatorcontrib>Cabacungan, Ashley N.</creatorcontrib><creatorcontrib>Boulware, L. Ebony</creatorcontrib><title>Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD</title><title>Kidney medicine</title><addtitle>Kidney Med</addtitle><description>Choosing from multiple kidney failure treatment modalities can create decisional conflict, but little is known about this experience before decision implementation. We explored decisional conflict about treatment for kidney failure and its associated patient characteristics in the context of advanced chronic kidney disease (CKD).
Cross-sectional study.
Adults (N = 427) who had advanced CKD, received nephrology care in Pennsylvania-based clinics, and had no history of dialysis or transplantation.
Participants’ sociodemographic, physical health, nephrology care/knowledge, and psychosocial characteristics.
Participants’ results on the Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) screening test for decisional conflict (no decisional conflict vs decisional conflict).
We used multivariable logistic regression to quantify associations between aforementioned participant characteristics and decisional conflict. We repeated analyses among a subgroup of participants at highest risk of kidney failure within 2 years.
Most (76%) participants reported treatment-related decisional conflict. Participant characteristics associated with lower odds of decisional conflict included complete satisfaction with patient–kidney team treatment discussions (OR, 0.16; 95% CI, 0.03-0.88; P = 0.04), attendance of treatment education classes (OR, 0.38; 95% CI, 0.16-0.90; P = 0.03), and greater treatment-related decision self-efficacy (OR, 0.97; 95% CI, 0.94-0.99; P < 0.01). Sensitivity analyses showed a similarly high prevalence of decisional conflict (73%) and again demonstrated associations of class attendance (OR, 0.26; 95% CI, 0.07-0.96; P = 0.04) and decision self-efficacy (OR, 0.95; 95% CI, 0.91-0.99; P = 0.03) with decisional conflict.
Single-health system study.
Decisional conflict was highly prevalent regardless of CKD progression risk. Findings suggest efforts to reduce decisional conflict should focus on minimizing the mismatch between clinical practice guidelines and patient-reported engagement in treatment preparation, facilitating patient–kidney team treatment discussions, and developing treatment education programs and decision support interventions that incorporate decision self-efficacy–enhancing strategies.
[Display omitted]</description><subject>Chronic kidney disease</subject><subject>decisional conflict</subject><subject>dialysis</subject><subject>Original Research</subject><subject>transplant</subject><subject>treatment decision-making</subject><issn>2590-0595</issn><issn>2590-0595</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kc9rFDEUx4MottT-Az1Ijl52TTL5sQMiLNtWpS29VLwUQiZ502bNTGqSWex_b4atpV485ZF83jeP90HohJIlJVR-3C5__xxgyQhj9YIIRl-hQyZasiCiFa9f1AfoOOctIZXkUlL-Fh00krREKXaIbk_B-uzjaALexLEP3ha87uJU8IV3Izzic-PDlADfJDBlgLHgq-hM8MVDxushjnd47aZQMv7hy32td2a04PDm4vQdetObkOH46TxC38_PbjZfF5fXX75t1pcLy4UoC1ipzrlWKN6bxnEmV50RlhgjQRqpHJG0ty1XTLWsk-Aq1xlgkotGkBWF5gh93uc-TN0AztYhkwn6IfnBpEcdjdf_voz-Xt_FnW45b1dC1YAPTwEp_pogFz34bCEEM0KcsmaKNg2RhM8o26M2xZwT9M_fUKJnM3qrZzN6NqP3ZmrT-5cDPrf89VCBT3sA6pp2HpLO1sO8R5_AFu2i_1_-H_pjoAI</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>DePasquale, Nicole</creator><creator>Green, Jamie A.</creator><creator>Ephraim, Patti L.</creator><creator>Morton, Sarah</creator><creator>Peskoe, Sarah B.</creator><creator>Davenport, Clemontina A.</creator><creator>Mohottige, Dinushika</creator><creator>McElroy, Lisa</creator><creator>Strigo, Tara S.</creator><creator>Hill-Briggs, Felicia</creator><creator>Browne, Teri</creator><creator>Wilson, Jonathan</creator><creator>Lewis-Boyer, LaPricia</creator><creator>Cabacungan, Ashley N.</creator><creator>Boulware, L. Ebony</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220901</creationdate><title>Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD</title><author>DePasquale, Nicole ; Green, Jamie A. ; Ephraim, Patti L. ; Morton, Sarah ; Peskoe, Sarah B. ; Davenport, Clemontina A. ; Mohottige, Dinushika ; McElroy, Lisa ; Strigo, Tara S. ; Hill-Briggs, Felicia ; Browne, Teri ; Wilson, Jonathan ; Lewis-Boyer, LaPricia ; Cabacungan, Ashley N. ; Boulware, L. Ebony</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c455t-e87bdd9574fa3d4268ba5c0aa6e6a67d061fc9472792b6ed74fbae264535081e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Chronic kidney disease</topic><topic>decisional conflict</topic><topic>dialysis</topic><topic>Original Research</topic><topic>transplant</topic><topic>treatment decision-making</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DePasquale, Nicole</creatorcontrib><creatorcontrib>Green, Jamie A.</creatorcontrib><creatorcontrib>Ephraim, Patti L.</creatorcontrib><creatorcontrib>Morton, Sarah</creatorcontrib><creatorcontrib>Peskoe, Sarah B.</creatorcontrib><creatorcontrib>Davenport, Clemontina A.</creatorcontrib><creatorcontrib>Mohottige, Dinushika</creatorcontrib><creatorcontrib>McElroy, Lisa</creatorcontrib><creatorcontrib>Strigo, Tara S.</creatorcontrib><creatorcontrib>Hill-Briggs, Felicia</creatorcontrib><creatorcontrib>Browne, Teri</creatorcontrib><creatorcontrib>Wilson, Jonathan</creatorcontrib><creatorcontrib>Lewis-Boyer, LaPricia</creatorcontrib><creatorcontrib>Cabacungan, Ashley N.</creatorcontrib><creatorcontrib>Boulware, L. Ebony</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Kidney medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DePasquale, Nicole</au><au>Green, Jamie A.</au><au>Ephraim, Patti L.</au><au>Morton, Sarah</au><au>Peskoe, Sarah B.</au><au>Davenport, Clemontina A.</au><au>Mohottige, Dinushika</au><au>McElroy, Lisa</au><au>Strigo, Tara S.</au><au>Hill-Briggs, Felicia</au><au>Browne, Teri</au><au>Wilson, Jonathan</au><au>Lewis-Boyer, LaPricia</au><au>Cabacungan, Ashley N.</au><au>Boulware, L. Ebony</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD</atitle><jtitle>Kidney medicine</jtitle><addtitle>Kidney Med</addtitle><date>2022-09-01</date><risdate>2022</risdate><volume>4</volume><issue>9</issue><spage>100521</spage><pages>100521-</pages><artnum>100521</artnum><issn>2590-0595</issn><eissn>2590-0595</eissn><abstract>Choosing from multiple kidney failure treatment modalities can create decisional conflict, but little is known about this experience before decision implementation. We explored decisional conflict about treatment for kidney failure and its associated patient characteristics in the context of advanced chronic kidney disease (CKD).
Cross-sectional study.
Adults (N = 427) who had advanced CKD, received nephrology care in Pennsylvania-based clinics, and had no history of dialysis or transplantation.
Participants’ sociodemographic, physical health, nephrology care/knowledge, and psychosocial characteristics.
Participants’ results on the Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) screening test for decisional conflict (no decisional conflict vs decisional conflict).
We used multivariable logistic regression to quantify associations between aforementioned participant characteristics and decisional conflict. We repeated analyses among a subgroup of participants at highest risk of kidney failure within 2 years.
Most (76%) participants reported treatment-related decisional conflict. Participant characteristics associated with lower odds of decisional conflict included complete satisfaction with patient–kidney team treatment discussions (OR, 0.16; 95% CI, 0.03-0.88; P = 0.04), attendance of treatment education classes (OR, 0.38; 95% CI, 0.16-0.90; P = 0.03), and greater treatment-related decision self-efficacy (OR, 0.97; 95% CI, 0.94-0.99; P < 0.01). Sensitivity analyses showed a similarly high prevalence of decisional conflict (73%) and again demonstrated associations of class attendance (OR, 0.26; 95% CI, 0.07-0.96; P = 0.04) and decision self-efficacy (OR, 0.95; 95% CI, 0.91-0.99; P = 0.03) with decisional conflict.
Single-health system study.
Decisional conflict was highly prevalent regardless of CKD progression risk. Findings suggest efforts to reduce decisional conflict should focus on minimizing the mismatch between clinical practice guidelines and patient-reported engagement in treatment preparation, facilitating patient–kidney team treatment discussions, and developing treatment education programs and decision support interventions that incorporate decision self-efficacy–enhancing strategies.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36090772</pmid><doi>10.1016/j.xkme.2022.100521</doi><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Chronic kidney disease decisional conflict dialysis Original Research transplant treatment decision-making |
| title | Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD |
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