An Initiative to Improve Nephrology Clinician Confidence in Shared Decision Making.

ABSTRACT:

Rationale & objective

Shared decision making (SDM) is the preferred model for medical decision making, but implementation in kidney failure treatment decisions remains suboptimal. We educated nephrology clinicians to engage in comprehensive SDM with empathetic communication.

Study design

Single-arm educational intervention with pre-post evaluation.

Setting & participants

Three virtual educational sessions for 80 nephrology clinicians from 14 nephrology practices in the Expanding and Promoting Alternative Care and Knowledge in Decision-Making (ExPAND) clinical trial.

Quality improvement activities

We educated nephrology clinicians to operationalize SDM, including presentation of active medical care without dialysis, using the Ask-Tell-Ask approach and empathetic communication.

Outcomes

Participants rated their pre- and postsession confidence in achieving the learning objectives and provided qualitative feedback.

Analytical approach

We used the Wilcoxon signed-rank paired test and obtained effect sizes (Cohen's r) to compare pre-post ratings.

Results

On a 7-point scale, median postsession confidence ratings increased 1 to 2 points from presession ratings for all learning objectives. The effect sizes (Cohen's r) for the increase were large for 12 of the 13 objectives. The 2 objectives showing the greatest improvement were using the 9 elements of SDM (2.00; 95% CI, 1.50-3.00; P < 0.001, r = 0.84) and delivering kidney disease education with a balanced presentation of all the options including active medical care without dialysis (2.00; 95% CI, 1.50-3.00; P < 0.001, r = 0.75). The qualitative feedback supported the quantitative results.

Limitations

Participant perceptions may not be generalizable to all nephrology clinicians. We did not measure whether improvements were retained over time or applied in practice.

Conclusions

The increase in clinician confidence suggests that our explicit instruction on how to conduct comprehensive SDM with empathetic communication may represent a breakthrough in improving the quality of SDM in the care of older patients with chronic kidney disease and kidney failure.

SUBMITTER: Pintea GI 

PROVIDER: S-EPMC12856478 | biostudies-literature | 2026 Feb

REPOSITORIES: biostudies-literature