Shared Decision Making Among Older Adults With Advanced CKD

Rationale & Objective: Older adults with advanced chronic kidney disease (CKD) face difficult decisions about dialysis initiation. Although shared decision making (SDM) can help align patient preferences and values with treatment options, the extent to which older patients with CKD experience SDM remains unknown. Study Design: A cross-sectional analysis of patient surveys examining decisional readiness, treatment options education, care partner support, and SDM. Setting & Participants: Adults aged 70 years or older from Boston, Chicago, San Diego, or Portland (Maine) with nondialysis advanced CKD. Predictors: Decisional readiness factors, treatment options education, and care partner support. Outcomes: Primary: SDM measured by the 9item Shared Decision Making Questionnaire (SDM-Q-9) instrument, with higher scores reflecting greater SDM. Exploratory: Factors associated with SDM. Analytical Approach: We used multivariable linear regression models to examine the associ- ations between SDM and predictors, controlling for demographic and health factors. Results: Among 350 participants, mean age was 78 +/- 6 years, 58% were male, 13% identified as Black, and 48% had diabetes. Mean SDM-Q-9 score was 52 +/- 28. SDM item agreement ranged from 41% of participants agreeing that "my doctor and I selected a treatment option together" to 73% agreeing that "my doctor told me that there are different options for treating my medical condition." In multivariable analysis adjusted for demographic characteristics, lower estimated glomerular filtration rate, and diabetes, being "well informed" and "very well informed" about kidney treatment options, having higher decisional certainty, and attendance at a kidney treatment options class were independently associated with higher SDM-Q-9 scores. Limitations: The cross-sectional study design limits the ability to make temporal associations between SDM and the predictors. Conclusions: Many older patients with CKD do not experience SDM when making dialysis decisions, emphasizing the need for greater access to and delivery of education for individuals with advanced CKD.