Work

An Initiative to Improve Nephrology Clinician Confidence in Shared Decision Making

Year: 2025

Type: article

Abstract: Rationale & Objective Shared decision-making (SDM) is the preferred model for medical decision making but implementation in kidney failure treatment decisions remains suboptimal. We educated nephrology clinicians to engage in comprehensive SDM with empathetic communication. Study Design Single-arm educational intervention with pre-post evaluation. Setting & Participants Three virtual educational sessions for 80 nephrology clinicians from 14 nephrology practices in the ExPAND clinical trial. Quality Improvement Activities We educated nephrology clinicians to operationalize SDM, including presentation of active medical care without dialysis, using the Ask-Tell-Ask approach and empathetic communication. Outcomes Participants rated their pre- and post-session confidence in achieving the learning objectives and provided qualitative feedback. Analytical Approach We used the Wilcoxon Signed-Rank paired test and obtained effect sizes (Cohen's r) to compare pre-post ratings. Results On a 7-point scale, median post-session confidence ratings increased 1 to 2 points from pre-session ratings for all learning objectives. The effect sizes (Cohen's r) for the increase were large for 12 of the 13 objectives. The two objectives showing the greatest improvement were using the nine elements of SDM (2.00, 95% CI 1.50 to 3.00; P < 0.001, r=0.84) and delivering kidney disease education with a balanced presentation of all the options including active medical care without dialysis (2.00, 95% CI 1.50 to 3.00; P < 0.001, r=0.75). The qualitative feedback supported the quantitative results. Limitations Participant perceptions may not be generalizable to all nephrology clinicians. We did not measure whether improvements were retained over time or applied in practice. Conclusions The increase in clinician confidence suggests that our explicit instruction on how to conduct comprehensive SDM with empathetic communication may represent a breakthrough in improving the quality of SDM in the care of older patients with chronic kidney disease and kidney failure.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2025.101209