Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease

Fangjian DUAN; Yu SHI; Qin XIE; Lei LEI; Jianping ZHANG; Chunmei LUO

doi:10.16016/j.2097-0927.202209216

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Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease

Clinical Medicine | 更新时间：2026-01-09

- Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease
- Journal of Army Medical University Vol. 44, Issue 21, Pages: 2217-2223(2022)
- 作者机构：
  
  1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院：骨科
  2.400037 重庆，陆军军医大学(第三军医大学)第二附属医院：肾内科
  3.400038 重庆，陆军军医大学(第三军医大学)：护理学院
  4.400038 重庆，陆军军医大学(第三军医大学)：第一附属医院肾内科
- 作者简介：
- 基金信息：
- DOI：10.16016/j.2097-0927.202209216
  CLC： R459.5;R473.5;R692.5
- Received：23 September 2022，
  
  Revised：2022-10-05，
  
  Published：15 November 2022
- 稿件说明：
移动端阅览
Fangjian DUAN, Yu SHI, Qin XIE, et al. Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease[J]. Journal of Army Medical University, 2022, 44(21): 2217-2223.
DOI：

Fangjian DUAN, Yu SHI, Qin XIE, et al. Efficacy of shared decision-making for dialysis treatment decisions in patients with end-stage renal disease[J]. Journal of Army Medical University, 2022, 44(21): 2217-2223. DOI： 10.16016/j.2097-0927.202209216.

摘要

目的

评估共享决策(shared decision making，SDM)干预的有效性，以期提高终末期肾脏病患者透析决策质量。

方法

采用随机对照的研究设计，纳入2021年10-12月重庆市4所三甲医院的72例终末期肾脏病患者，按照区组随机方法分配至干预组(

=36)或对照组(

=36)。干预组接受护士使用患者决策辅助工具(patient decision aids，PDA)进行决策辅导的SDM干预，对照组接受常规透析前教育。研究对象在干预1周后填写决策冲突量表、治疗选择问卷、医院焦虑抑郁量表、决策准备量表，透析后3个月完成SF-36量表和决策后悔量表。主要结局指标为决策冲突量表评分，次要结局指标为治疗选择、焦虑抑郁评分、决策准备评分、生活质量评分和决策后悔评分。

结果

在干预1周后，干预组的决策冲突评分(

＜0.01)、焦虑评分(

=0.005)显著低于对照组，干预组决策准备评分显著高于对照组(

＜0.01)，干预组对透析治疗不确定的比例显著低于对照组(15.15%

34.29%

=0.026)。在透析后3个月，干预组的生活质量评分中生理总评分显著高于对照组(

=0.004)，决策后悔评分显著低于对照组(

=0.002)。

结论

SDM干预可有效减少终末期肾脏病患者的决策冲突和决策后悔，减轻焦虑水平，同时改善患者的决策准备和生理健康。

Abstract

Objective

To evaluate the effectiveness of shared decision-making (SDM) interventions to improve the quality of dialysis decision-making in patients with end-stage renal disease.

Methods

A randomized controlled was carried out in 72 patients with end-stage renal disease recruited between October 2021 and December 2021. The patients were randomly assigned into the intervention group (

=36) or the control group (

=36). The intervention group was given SDM interventions in which the nurses used patient decision aids (PDA) for decision-making counseling

while the control group was given routine pre-dialysis education. All patients received the surveys of Decision Conflict Scale

Treatment Choice Questionnaire

Hospital Anxiety and Depression Scale

and Decision Readiness Scale in 1 week after the intervention

and 36-Item

Short Form Health Survey (SF-36) and Decision Regret Scale in 3 months after dialysis. The primary endpoint indicator was the score of Decision Conflict Scale

and the secondary ones were treatment choice

and scores of anxiety and depression

decision readiness

quality of life

and decision regret.

Results

After 1 week of intervention

the scores of decision conflict (

0.01) and anxiety (

=0.005) were significantly lower

while that of decision preparation (

0.01) was obviously higher in the intervention group than the control group. The proportion of uncertainty to dialysis in the intervention group was significantly lower than that of the control group (15.15%

34.29%

=0.026). In 3 months after dialysis

the intervention group obtained statistically higher total physiological score (

=0.004) and lower decision regret score (

=0.002) when compared with the control group.

Conclusion

SDM interventions can effectively reduce decision conflict and decision regret

reduce anxiety level

and improve decision preparation and physiological health for the patients with end-stage renal disease.

关键词

Keywords

references

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