Applied nursing research : ANR · 2026
Patient-provider partnership and advance care planning readiness among non-dialysis patients with chronic kidney disease.
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Hsu Jie-Ru, Lin Cheng-Pei, Lin Chih-Ching, Liu Chieh-Yu, Lai Chun-Fu, Wang Yu-Jen, Chen Yu-Chi
Аннотация
AIMS: To examine advance care planning (ACP) readiness among non-dialysis patients with chronic kidney disease (CKD) and to identify factors associated with readiness.
BACKGROUND: CKD progression is often marked by acute events and sudden deterioration, reflecting an unpredictable clinical course. ACP is increasingly advocated as an essential component of CKD care; however, discussions are frequently deferred until advanced stages of disease or the initiation of renal replacement therapy. Consequently, patients with non-dialysis CKD, who may benefit from anticipatory planning, remain underrepresented in the literature.
METHODS: A cross-sectional study adhering to STROBE guidelines was conducted. Participants were recruited from nephrology outpatient clinics and inpatient wards at a medical center using CKD stage-stratified quota sampling. Data were collected through self-administered questionnaires. ACP readiness was assessed using the readiness domain of the Advance Care Planning Engagement Survey. Demographic, clinical, and relational variables were measured. Descriptive statistics, non-parametric tests, and hierarchical regression analyses were conducted.
RESULTS: Among 218 participants, ACP readiness was low to modest, particularly for initiating discussions with healthcare providers. Demographic variables explained 6.1% of the variance, increasing to 8.0% with comorbidities and 12.7% with patient-provider partnership. Older age and stronger patient-provider partnerships were associated with higher readiness, whereas disease stage and renal function were not.
CONCLUSION: ACP readiness among non-dialysis patients with CKD is not solely determined by disease severity but is closely linked to relational aspects of care. Patient-provider partnership may serve as a key mechanism shaping readiness, underscoring the importance of relationship-centered approaches in facilitating engagement in ACP.
BACKGROUND: CKD progression is often marked by acute events and sudden deterioration, reflecting an unpredictable clinical course. ACP is increasingly advocated as an essential component of CKD care; however, discussions are frequently deferred until advanced stages of disease or the initiation of renal replacement therapy. Consequently, patients with non-dialysis CKD, who may benefit from anticipatory planning, remain underrepresented in the literature.
METHODS: A cross-sectional study adhering to STROBE guidelines was conducted. Participants were recruited from nephrology outpatient clinics and inpatient wards at a medical center using CKD stage-stratified quota sampling. Data were collected through self-administered questionnaires. ACP readiness was assessed using the readiness domain of the Advance Care Planning Engagement Survey. Demographic, clinical, and relational variables were measured. Descriptive statistics, non-parametric tests, and hierarchical regression analyses were conducted.
RESULTS: Among 218 participants, ACP readiness was low to modest, particularly for initiating discussions with healthcare providers. Demographic variables explained 6.1% of the variance, increasing to 8.0% with comorbidities and 12.7% with patient-provider partnership. Older age and stronger patient-provider partnerships were associated with higher readiness, whereas disease stage and renal function were not.
CONCLUSION: ACP readiness among non-dialysis patients with CKD is not solely determined by disease severity but is closely linked to relational aspects of care. Patient-provider partnership may serve as a key mechanism shaping readiness, underscoring the importance of relationship-centered approaches in facilitating engagement in ACP.