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Learning outcomes
On completion of this continuing professional development activity, participants should be able to:
* Articulate important evidence-based recommendations regarding shared decision making, for persons with chronic kidney disease.
* Suggest practical strategies to improve decision making, taking the individual's context into account.
* Recognise that shared decision making encompasses the entire realm of kidney disease,
* Suggest how decision aids may assist patients in recognising what's important to them.
* Reflect upon how clinicians may empower patients to recognise changing options as they develop, through their evolving disease trajectory.
* Acknowledge that not all patients with kidney disease wish to be actively involved in the shared decision-making process - although this should never be assumed.
Keywords
Evidence-based summaries, best practice, shared decision making, end-stage kidney disease, renal replacement therapy.
"You tell me and I forget,
you teach me and I may remember,
you involve me and I learn"
- Benjamin Franklin
Introduction
Chronic kidney disease (CKD) has five stages of disease progression, based on the glomerular filtration rate, with Stage 5 being end-stage kidney disease (ESKD). Stage 5 is also sometimes referred to as end-stage renal disease (ESRD). For patients with ESKD, treatment options include pre-emptive transplantation, peritoneal dialysis (PD), in-centre haemodialysis (HD), home HD or supportive non-dialytic management, also known as conservative care (Morton et ai, 2011). Shared decision making (often referred to as SDM) allows a clinician and patient to participate jointly in making a health decision, taking into account the benefits and harms of all the options and considering the patient's values, preferences and circumstances (Hoffman etai., 2014; Murray era/., 2013). SDM has also been described "as a decision situation, in which 1) at least two participants are involved, who 2) both share information and 3) take steps to build a consensus about the preferred treatment, and where 4) an agreement is reached on the treatment with joint responsibility" (Robinski eta!., 2016, p. 563), Renal function in patients with CKD usually declines gradually, which provides multiple opportunities for clinicians to discuss renal replacement therapy (RRT) and supportive care with patients and their families (Tuso, 2013). The importance of initiating discussions about RRT or conservative care earlier in the disease progression has been highlighted, with SDM considered critical when the...