| Objective1.Quantitative and qualitative and studies were conducted to investigate the needs of patients with advanced kidney disease to participate in the decision-making of dialysis modality,and to construct an intervention programme for patients with advanced chronic kidney disease to participate in the decision-making of dialysis modality.2.To explore the implementation effect of the intervention program for patients with advanced chronic kidney disease to participate in the decision-making of dialysis modality,so as to provide guidance for promoting patients’ participation in clinical decision-making in the future.MethodsThis study is divided into two parts:Intervention program construction stage:(1)Quantitative survey: patients with advanced chronic kidney disease who met the inclusion criteria in a 3A grade hospital in Zhengzhou from August 2019 to December 2019 were selected as the questionnaire subjects.The survey tools were general information questionnaire and the expectation scale for patients to participate in medical decision-making,and the differences in the needs for patients with different characteristics to participate in medical decision-making were analyzed.Using the IBM SPSS,23.0 and descriptive statistics,one-way analysis of variance(ANVOA),chi-square to analyze the data,inspection level for α= 0.05.(2)Qualitative research: Semi-structured in-depth interviews were conducted on patients with end-stage renal disease to analyze and summarize the needs and difficulties arising from patients’ participation in the decision-making process.Based on the theoretical framework,quantitative and qualitative research results,the intervention programme of dialysis modality decision-making for patients with advanced chronic kidney disease was preliminarily formulated,and the intervention programme was modified through the localization of manual,expert consultation and pre-experiment,so as to make it more operable and scientific.Intervention stage: The intervention programme was evaluated by quasi-experimental research.Eighty-four patients with advanced chronic kidney disease who met the inclusion criteria and voluntarily participated in the two districts of the Department of Nephrology of a Grade 3 A hospital in Zhengzhou were selected as the intervention objects.The patients in the intervention group and the control group were divided according to the drawing method according to the unit of the hospital district.The control group received routine predialysis education,and the intervention group received the intervention programme based on routine predialysis education for patient involvement in decision-making programme.Collecting before the intervention of patients with general information,serum albumin level and expected to decision-making role,decision conflict,patient participation ability scores,then collect the decision conflicts after intervention scoring and decision-making role expectation,after 1 month of the intervention to collect their patients to participate in the ability to score and serum albumin levels,after 3 month of the intervention/actual decisional time,collecting the expected to decision-making role,actual decision participation,decisional conflict scores,patients’ participation ability score,serum albumin level and dialysis access preparation.Descriptive statistics,chi-square test,rank sum test,and generalized estimation equation were used for statistical analysis of the data.Test level α = 0.05.Results1.Intervention programme construction stage:(1)Quantitative study: A total of 245 questionnaires were sent out in this study,among which 237 were effective,with an effective rate of 96.7%.(1)In this study,the score of the expectation for patients with advanced chronic kidney disease participation in medical decisions range 20 ～ 58,the score was(40.94±8.30),the average score was(3.41±0.69),the score of the information requirement was the highest(12.08 ±1.87),the average score was(4.03±0.62)point,the score of decision-making needs was the lowest(8.36±2.96),the average score was(2.79±0.99),the score of communication requirement was(20.49±4.94),the average score was(3.42±0.82).(2)Statistical methods such as chi-square test,two independent t test and correlation analysis were used to analyze the influencing factors of patients’ requirement for participation in medical decision-making.The regression results showed that education level was the influencing factor of patients’ demand for information,education level,economic status and marital status were the influencing factors of patients’ demand for communication,while educational level were the influencing factors of patients’ demand for decision-making.(2)Qualitative research: A total of 15 patients with end-stage renal disease were selected for the semi-structured interview.The subjects were summarized as follows:(1)Conceptual dilemma(delayed decision intention,passive decision role,family concept conflict);(2)Emotional predicament(panic fear,uncertainty,guilt,deprivation);(3)Information dilemma(lack of information,information confusion);(4)Communication dilemma(lack of communication,understanding deviation,poor communication);(5)External decision support(multi-social support staff,individualized tools,strong health policy);(6)Decisional literacy(decision-making sensitivity,decision-making self-efficacy,logical judgment ability);(7)Appropriate decision timing(pre-decision timing,actual decision timing);2.Implementation phase of the intervention programme(1)Fisher’s exact test was performed on the expected decision role and actual decision participation of patients in the two groups,and the results showed that there were statistical differences in the expected decision role and actual decision participation between the intervention group and the control group(P<0.05).There were statistically significant differences in the expected decision-making roles of patients in the intervention group before and after intervention(P<0.05).(2)More than 90% of the patients in the intervention group thought that the patient decision-making intervention plan was "relatively helpful" and "very helpful".(3)Repeated measure ANOVA was performed on the total score of decision conflict before and after intervention,and the results showed that there were statistically significant differences in interaction effect,inter-group effect and time effect(P<0.05),the generalized estimation equation was used to analyze the dimensions of decision conflict,and the results showed that there were statistical differences in the interaction effects among groups,time and time(P<0.05).(3)Generalized estimation equation was performed on the total scores and each dimension of patients’ participation ability before and after intervention in the two groups,and the results showed that there were statistical differences in the total scores and dimensions of information acquisition,communication and autonomous decision-making among groups,time and interaction effects(P<0.05),the score of emotion management dimension had no statistical difference in interaction effect(P>0.05),and there were statistically significant differences in time and inter-group effect(P<0.05).(4)Objective indicators: Generalized estimation equation of serum albumin was performed between the two groups,and the results showed that there was no statistically significant difference in the interaction effect(P>0.05),and there were statistically significant differences in time and effect between groups(P<0.05);Chi-square test was conducted on dialysis access readiness of patients in the two groups,and the results showed that there was a statistical difference in dialysis access readiness of patients in the two groups(P<0.05).Conclusions1.In this study,patients with advanced chronic kidney disease had a higher requirement for participation in decision-making process,among which there were differences in information needs of patients with different educational level,communication needs of patients with different educational levels and economic status and marital status,and decision-making needs of patients with different educational level and economic status.2.Patients with end-stage renal disease encounter difficulties in concept,information,communication and emotion in the decision-making process,accompanied by the emergence of the need for decision support system,their own decision literacy and appropriate decision timing.3.Intervention programs for patients with advanced chronic kidney disease to participate in decision-making can stimulate patients’ decision-making willingness and behaviors,help patients prepare for decision-making,reduce patients’ decision-making conflict level,enhance patients’ participation ability and can be included in pre-dialysis service content. |
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