Shared decision-making process and its influencing factors among patients undergoing kidney replacement therapy: a qualitative descriptive study.

BACKGROUND

Patients with end‑stage kidney disease (ESKD) often struggle to choose among kidney replacement therapy options due to information ambiguity and the complexity of treatment pathways. In nursing, comprehensive, person-centered care has become more popular, placing a strong emphasis on advocacy and the defense of patients' rights. Discussions about the value of patient-physician collaboration in decision-making, patient involvement strategies, and the nuances of decision-making processes have resulted from this. Currently, there is a steady increase in research on dialysis modality decision-making for patients with end-stage kidney disease (ESKD). However, more comprehensive context-specific conceptual frameworks are still needed to support this research.

OBJECTIVE

This study is aim to examine the kidney replacement therapy decision-making process and its influencing factors among patients with ESKD in the nephrology department of a tertiary hospital in China, contributing to a broader shared decision-making paradigm.

METHODS

Twelve patients with ESKD participated in face-to-face interviews using a semi-structured format to facilitate an in-depth understanding of their experiences. The qualitative data from these interviews underwent an inductive thematic analysis to identify underlying themes and patterns. The interview data were coded at three distinct levels using NVIVO 12.0 software, ensuring a thorough and nuanced interpretation.

RESULTS

Primary results of analysis of the experiences included three main themes with eight subthemes generated from the data: (1) The precondition: symptom perception (physical and psychological perceptions); (2) The dilemma: information and communication (information dilemma and communication dilemma); (3) The outcome: decision-making behavior (personal, family, social, and therapeutic factors).

CONCLUSIONS

Patients' kidney replacement therapy decision‑making process involves three stages: symptom perception as a precondition, dilemmas in information and communication, and multifaceted decision‑making behaviors influenced by personal, familial, social, and therapeutic factors. The results of this study offer a theoretical basis for supporting clinical decision-making practices that align with patients' experiences and values. To improve information distribution, patient decision aids can be created, and information technology can give broad decision support that matches patients' values.

CLINICAL TRIAL NUMBER: Not applicable.