Patient-provider partnership and advance care planning readiness among non-dialysis patients with chronic kidney disease.

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.