The Effects of Shared Decision Making on Different Renal Replacement Therapy Decisions in Patients With Chronic Kidney Disease

10.1097/jnr.0000000000000386

Ya-Fang HO；Yu-Chi CHEN；Chiu-Chin HUANG；Wen-Yu HU；Kuan-Chia LIN；I-Chuan LI

chronic kidney disease ； renal replacement therapy ； shared decision-making ； decision self-efficacy ； decisional conflict

The Journal of Nursing Research

28卷4期（2020 / 08 / 01）

1 - 10

英文

Background: The prevalence and incidence of end-stage renal disease (ESRD) in Taiwan are the highest of any country in the world. The different renal replacement therapies that are adopted by patients with ESRD significantly affect their social roles and daily life. However, because of the complexities of different renal replacement therapies, patients may be unsure of which to choose. Purpose: The aim of this study was to explore the effectiveness of a shared decision-making (SDM) program regarding different renal replacement therapies for patients with chronic kidney disease. Methods: A quasi-experimental design was conducted at two similar regional hospitals in Miaoli County, Taiwan. One hospital hosted the intervention group, and the other hospital hosted the control group. The 31 participants in the intervention group took part in a SDM program. The 36 control group participants took part in the pre-ESRD care program. Data collection included demographic and disease characteristics, decisional conflict scale, and decision self-efficacy scale. Results were analyzed using independent t test, Fisher's exact test, generalized estimating equation, and paired t tests. Results: The study results revealed that the intervention group experienced a significant increase in decision self-efficacy and a significant decrease in decisional conflict at 1 month after receiving the SDM intervention in comparison to before and immediately after receiving the intervention. Moreover, the intervention group had higher decision self-efficacy and lower decisional conflict than the control group. Conclusions/Implications for Practice: The SDM program may be an effective intervention for complex decision-making processes, such as the process involved in making renal replacement treatment decisions. The SDM program group intervention improved decisional conflict and decision self-efficacy. Thus, to improve patients' decision-making processes, the application of an SDM program focused on the personal values and opinions of patients with ESRD will be necessary. Physicians and case managers of patients with ESRD should act in complementary and cooperative roles in SDM programs.

1. Chiaranai, C.(2016).The lived experience of patients receiving hemodialysis treatment for end-stage renal disease: A qualitative study.The Journal of Nursing Research,24(2),101-108.
   連結：
2. Hsiao, C. Y.,Lin, L. W.,Su, Y. W.,Yeh, S. H.,Lee, L. N.,Tsai, F. M.(2016).The effects of an empowerment intervention on renal transplant recipients: A randomized controlled trial.The Journal of Nursing Research,24(3),201-210.
   連結：
3. Lai, M. J.,Chou, C. Y.,Lu, S. H.(2018).Factors associated with starting dialysis using a temporary catheter among patients with chronic kidney disease.VGH Nursing,35(3),278-288.
   連結：
4. Lee, S. C.(2016).Treatment decision making process of cancer patients.The Journal of Nursing,63(5),12-18.
   連結：
5. Bailey, R. A.,Pfeifer, M.,Shillington, A. C.,Harshaw, Q.,Funnell, M. M.,VanWingen, J.,Col, N.(2016).Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict.BMC Health Services Research,16,10.
6. Bandura, A.(1977).Self-efficacy: Toward a unifying theory of behavioral change.Psychological Review,84(2),191-215.
7. Berrios-Rivera, J. P.,Street, R. L., Jr.,Garcia Popa-lisseanu, M. G.,Kallen, M. A.,Richardson, M. N.,Janssen, N. M.,SuarezAlmazor, M. E.(2006).Trust in physicians and elements of the medical interaction in patients with rheumatoid arthritis and systemic lupus erythematosus.Arthritis and Rheumatism,55(3),385-393.
8. Bunn, H.,O'Connor, A.(1996).Validation of client decisionmaking instruments in the context of psychiatry.Canadian Journal of Nursing Research,28(3),13-27.
9. Causarano, N.,Platt, J.,Baxter, N. N.,Bagher, S.,Jones, J. M.,Metcalfe, K. A.,Zhong, T.(2015).Pre-consultation educational group intervention to improve shared decision-making for postmastectomy breast reconstruction: A pilot randomized controlled trial.Support Care Cancer,23(5),1365-1375.
10. Charles, C.,Gafni, A.,Whelan, T.(1997).Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango).Social Science & Medicine,44(5),681-692.
11. Charles, C.,Gafni, A.,Whelan, T.(1999).Decision-making in the physician-patient encounter: Revisiting the shared treatment decision-making model.Social Science & Medicine,49(5),651-661.
12. Chen, H. D.(Ed.)(2008).The Lancet handbook of essential concepts in clinical research.Taipei City, Taiwan, ROC:Elsevier Taiwan.
13. Cohen, J.(1992).A power primer.Psychological Bulletin,112(1),155-159.
14. Gionfriddo, M. R.,Leppin, A. L.,Brito, J. P.,Leblanc, A.,Boehmer, K. R.,Morris, M. A.,Montori, V. M.(2014).A systematic review of shared decision making interventions in chronic conditions: A review protocol.Systematic Reviews,3,38.
15. Kane, H. L.,Halpern, M. T.,Squiers, L. B.,Treiman, K. A.,McCormack, L. A.(2014).Implementing and evaluating shared decision making in oncology practice.CA: A Cancer Journal for Clinicians,64(6),377-388.
16. Lee, Y. Y.,Lin, J. L.(2008).Patient-physician trust, outcome expectations and self-efficacy in diabetic patients' self-care.Taipei City Medical Journal,5(3),304-319.
17. Légaré, F.,Leblanc, A.,Robitaille, H.,Turcotte, S.(2012).The decisional conflict scale: Moving from the individual to the dyad level.The Journal of Evidence and Quality in Health Care,106(4),247-252.
18. Liyanage, T.,Ninomiya, T.,Jha, V.,Neal, B.,Patrice, H. M.,Okpechi, I.,Perkovic, V.(2015).Worldwide access to treatment for end-stage kidney disease: A systematic review.The Lancet,385(9981),1975-1982.
19. Ministry of Health and Welfare, Taiwan, ROC. (2018). Nationwide multidisciplinary pre-end stage renal disease (pre-ESRD) care program. Retrieved from https://www.nhi.gov.tw/Content_List.aspx?n=D5CC89AE36D48E5E&topn=CA428784F9ED78C9(Original work published in Chinese)
20. National Health Research Institutes, Taiwan, ROC. (2015). Timing, preparation and selection of patients with chronic kidney disease receiving renal replacement therapy. 2015 Taiwan chronic kidney disease clinical guidelines. Retrieved from http://w3.nhri.org.tw/nhri_org/rl/lib/NewWeb/nhri/html/B-5/B-5_son_05.htm#I (Original work published in Chinese)
21. Obeidat, R. F.,Homish, G. G.,Lally, R. M.(2013).Shared decision making among individuals with cancer in non-Western cultures: A literature review.Oncology Nursing Forum,40(5),454-463.
22. O'Connor, A. M.(1995).Validation of a decisional conflict scale.Medical Decision Making,15(1),25-30.
23. Ottawa Hospital and Health Research Institute. (2015). Traditional decisional conflict scale (DCS)-Statement format: 16 Item 5 response categories. Retrieved from https://decisionaid.ohri.ca/eval_dcs.html
24. Ottawa Hospital and Health Research Institute. (2014). Sample tool: Decision self-efficacy. Retrieved from https://decisionaid.ohri.ca/eval_self.html
25. Stacey, D.,Légaré, F.,Col, N. F.,Bennett, C. L.,Barry, M. J.,Eden, K. B.,Wu, J. H.(2014).Decision aids for people facing health treatment or screening decisions.The Cochrane Database of Systematic Reviews,4,CD001431.
26. Sun, W. N.,Hsu, H. T.(2017).Discourse of decision conflict.The Kaohsiung Journal of Nursing,34(1),25-35.
27. Taiwan Society of Nephrology, Taiwan, ROC. (2018). 2018 Annual report on kidney disease in Taiwan. Retrieved from https://www.tsn.org.tw/UI/L/L002.aspx (Original work published in Chinese)
28. U.S. Renal Data System. (2018). 2018 ADR chapters: End-stage renal disease (ESRD) in the United States-International comparisons. https://www.usrds.org/2018/view/Default.aspx

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