Outcomes of the Application of Decision Aid for Renal Replacement Therapy in Patients with Chronic Kidney Disease in a Southern Community Hospital

Abstract

Objective: To study outcomes of the application of a decision-support tool for chronic kidney disease (CKD) patients in making decisions on renal replacement therapy (RRT) in a community hospital in the south.  Methods: The research was a mixed-method design of a qualitative study and a quantitative study with quasi-experimental design in one group with pretest and posttest between August 2021 and January 2024. Study consisted of three phases. The first phase involved the identification of factors influencing decisions on RRT. The second phase was the development of a decision-support tool comprising a set of decision aids, a decision-making support guide, and a decision-making rationale assessment scale. The third phase involved the study of outcomes of the application of tools in 60 purposively selected CKD patients. Data were collected before and two months after the intervention including decision-making on RRT, decisional conflict, self-efficacy, and relevant knowledge. Results: All tools in the study showed Cronbach’s alpha > 0.7. After implementing the intervention, the number of patients who accepted RRT increased from 3 (5%) to 26 (43.33%), while those declining RRT decreased from 57 (95%) to 34 (56.67%). Average knowledge score increased from 2.53 ± 1.52 to 7.08 ± 1.05 (out of 10). Mean decisional conflict score decreased from 51.54 ± 13.10 to 25.50 ± 9.30 (out of 100). Mean self-efficacy score increased from 50.08 ± 16.77 to 67.92 ± 14.30 (out of 100). All changes reached statistically significant levels (P<0.001). Conclusion: The decision-support tool enhanced patients' knowledge and understanding of treatment options, facilitated individualized problem-solving, reduced decisional conflict, and increased the likelihood of choosing RRT.