News Release

Tool helps measure patients' readiness to make decisions about starting dialysis

Patients benefit when empowered to make informed decisions about their care

Peer-Reviewed Publication

American Society of Nephrology

Highlights

  • A new algorithm is a useful tool for measuring chronic kidney disease patients' readiness for making decisions about initiating dialysis.

  • Patients who have knowledge about their options and have fewer lifestyle barriers to home dialysis are more likely to be ready to make decisions. Doctors who explain all of the treatment options that are available can increase patients' readiness for decision-making.

  • An estimated 26 million people in the United States have chronic kidney disease.

Washington, DC (January 15, 2015) -- Patients with advanced chronic kidney disease (CKD) are often faced with difficult medical choices, such as whether to start dialysis or undergo kidney transplantation, and many patients may not feel ready to make treatment decisions for a variety of reasons. A new tool may help health professionals assess kidney disease patients' readiness to make important life-changing treatment decisions around their dialysis care. The tool is described in a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN).

Investigators led by Suma Prakash, MD, FRCPC, MSc (Case Western Reserve University) wondered whether a model called the "behavioral stage of change" model, which was originally used to help people quit smoking, might help patients with chronic kidney disease take action and make decisions about their dialysis options.

The team developed a tool based on the stage of change algorithm and used it in surveys with 55 patients with CKD. Sixty-five percent of patients were in a precontemplation/contemplation (thinking) stage and 35% were in a preparation/maintenance (acting) stage. The researchers found that the algorithm was a useful tool in measuring patients' readiness for dialysis decision-making. Patients who had knowledge about their options and had fewer lifestyle barriers to home dialysis were more likely to be ready to make decisions. Also, clinicians who explained the available options for treatment helped increase patients' readiness for decision-making.

"Focusing on understanding the decision-making process from patients' perspectives allows us as medical professionals to help patients make timely decision about their options," said Dr. Prakash. "Some potential impacts of reaching this goal are that patients might opt more for home dialysis options, and more patients may be able to start their preferred option in a non-urgent manner and not require admission to hospital to start dialysis."

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Study co-authors include Anna McGrail, Steven Lewis, MS, Jesse Schold, PhD, Mary Ellen Lawless, MA, Ashwini Sehgal, MD, and Adam Perzynski PhD.

Disclosures: Baxter provided a small grant for this study, which was also supported in parts by grants from the National Institutes of Health.

The article, entitled "Behavioral Stage of Change and Dialysis Decision Making," will appear online at http://cjasn.asnjournals.org/ on January 15, 2015.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.


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