Perceived Shared Decision Making during Maintenance Hemodialysis: Associations with Health Literacy, Social Deprivation, and Care Setting.

KEY POINTS: Perceived shared decision making during routine hemodialysis care was low and heterogeneous across patients. Higher communicative and critical health literacy and lower deprivation were associated with higher perceived shared decision-making. Dialysis autonomy and unit type were associated with perceived shared decision making, suggesting organizational targets for patient-centered care.

BACKGROUND

Shared decision-making (SDM) is a core component of patient-centered care. In CKD, SDM research has largely focused on dialysis modality choice, with limited attention to routine clinical decisions during maintenance hemodialysis. We assessed patients' perceived SDM during routine hemodialysis care and examined individual and contextual factors associated with perceived SDM.

METHODS

A multicenter, cross-sectional, observational study was conducted among adult patients receiving maintenance hemodialysis at the Centre Associatif Lyonnais De Dialyse dialysis network in the Rhône-Alpes region, France. Data were collected during routine dialysis sessions over a 2-week period from June 24 to July 6, 2024. Independent variables included individual characteristics (age, sex, education, health literacy [HL]), socioeconomic deprivation (European Deprivation Index), dialysis autonomy, dialysis unit type, and decision characteristics. Perceived SDM was assessed using the nine-item SDM Questionnaire (SDM-Q-9). Univariable analyses and multivariable linear regression were performed to identify factors associated with SDM-Q-9 scores.

RESULTS

Among 104 participants (75% male; 88% older than 50 years; 64% retired), the mean SDM-Q-9 score (0-100 scale) was 24.3±26.1 (median, 13.3), indicating low perceived SDM. Most reported decisions concerned dialysis management (57%), followed by medication-related decisions (26%) and comorbidity management (17%). In multivariable linear regression analysis, higher communicative ( β =2.48; 95% confidence interval [CI], 0.89 to 4.07; P = 0.003) and critical HL ( β =3.01; 95% CI, 1.12 to 4.90; P = 0.002) were associated with higher SDM-Q-9 scores, whereas greater socioeconomic deprivation was associated with lower scores ( β =-1.12; 95% CI, -2.05 to-0.19; P = 0.02). Dialysis unit type, dialysis autonomy, and employment status were also associated with SDM-Q-9 scores.

CONCLUSIONS

Perceived SDM during routine hemodialysis care was generally low and heterogeneous. HL, socioeconomic deprivation, dialysis autonomy, and care setting were associated with perceived SDM. Dialysis vintage was not recorded and not included in the analyses. Interventions addressing HL-sensitive communication and organizational factors may improve patient-centered decision making in hemodialysis care.