Shared patient and provider values in end-stage renal disease decision making: Identifying the tensions. Issue 7 (July 2019)

• Record Type: Journal Article
• Authors: Vandenberg, Ann E.; Bowling, C. Barrett; Adisa, Olufunmilola; Sahlie, Abyalew; Nadel, Leigh; Lea, Janice; Plantinga, Laura C.
• Is Part Of: Patient education and counseling. Volume 102:Issue 7(2019)
• Page Start: 1280
• Page End: 1287
• Publication Date: 2019-07
• Subjects: Renal dialysis -- End-stage renal disease -- Decision making -- Social values -- Physician-patient communication; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2019.02.012
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Dialysis patients and providers make frequent, ongoing decisions to optimize care. Patient and provider values are key for shared decision-making (SDM). Shared values include informing patient (communication) and function (information). Physicians' value of proprietary information on function/prognosis may impede SDM. Patients' valued outcome of social participation may inform decision-making. Abstract: Objective: To examine concordance and tensions in values among stakeholder groups across the shared decision making process for end-stage renal disease patients treated with hemodialysis. Methods: A thematic analysis of transcripts from three stakeholder groups: hemodialysis patients (2 groups, n = 17), nephrologists (1 group, n = 9), and non-physician providers (dietitians, social workers, and registered nurses) (1 group, n = 8). A framework of decision-making components (communication, information, decision, behavior, and outcome) guided analysis of values within and across groups. Results: Shared values included communication that informed patients and involved family; information about function, trajectory, life context, and patient experience; behavior to manage diet; and outcomes of function, safety, and survival. Identified thematic tensions in patient-provider values were: personalized vs. routinized communication; shared vs. separate information; managed vs. adherent behavior; and participating vs. protected outcome. Patient behavior emerged as a contested area of control. Conclusion: Emphasizing shared values and bridging values conflicts may ease tensions surrounding self-care behavior by facilitating discussions about diet, medications, and consistent dialyzing. Practice implications: More individualized information needs to be delivered to patients in a personalized communication approach that can still be achieved within a busy dialysis clinic setting.