| Objective:Most patients with end-stage renal disease need long-term dialysis to maintain their lives.Each dialysis mode has its advantages and disadvantages.Patients often face serious decision-making conflicts.Moreover,different dialysis methods will have a huge impact on the patients quality of life,health status,daily life and economic burden.Therefore,this study intended to explore the experience of patients with end-stage renal disease in participating in the dialysis treatment decision-making process,and develop a localized treatment decision-making aid for patients with end-stage renal disease.The clinical application of the aid was evaluated through randomized controlled trials,so as to support the dialysis treatment decisions of patients with end-stage renal disease,enhance their ability to participate in and share the decisions,assist patients to select the dialysis treatment wisely,and improve the quality of dialysis decisions for patients with end-stage renal disease.Methods:1.A semi-structured in-depth interview was conducted to investigate the experience and needs of 12 patients with end-stage renal disease receiving dialysis treatment.The data were analyzed using the Colaizzi seven-step analysis method.2.The content framework of the patient decision support tool was constructed based on the international standards for patient decision support tools and the preliminary semi-structured interview results of the research group.sixteen experts were invited to conduct two rounds of delphi expert consultation on the content framework of the patient decision support tool,and the specific content of the patient decision support tool was filled in according to evidence-based medical evidence to form a revised version of the content of the decision support tool for treatment of patients with end-stage renal disease.finally,the revised handbook of the patient decision support tool was distributed to patients and medical staff for pilot testing,and revised and debugged to form a final version of the patient decision support tool.3.In a multi-center randomized controlled study design,72 enrolled patients with end-stage renal disease were randomly assigned to an intervention group(n=36)or a control group(n=36)according to the block method from October 2021 to December 2021.The intervention group received the shared decision-making intervention model in which nurses used decision-making aids for decision-making counseling,and the control group received routine pre-dialysis education.After one week of intervention,the subjects completed the decision conflict scale,treatment selection questionnaire,hospital anxiety and depression scale,and decision preparation scale.After three months of dialysis,they completed the SF-36 scale and decision regret scale.Outcome indicators were decision conflict scale score,treatment choice,anxiety and depression score,decision preparation score,quality of life score and decision regret score.Results:1.The experience of patients with end-stage renal disease in participating in the dialysis decision-making process extracts a total of four themes,namely,insufficient cognition on disease treatment,obstacle to access to professional information,lack of independent decision-making ability,and heavy burden of dialysis treatment.2.The first edition of the constructed decision support tool for patients with end-stage renal disease undergoing dialysis treatment includes 5 primary indicators,28 secondary indicators and the specific contents of subordinates.The recovery rates of effective questionnaires from experts in two rounds were 81.25% and 100%,respectively.The expert authority coefficients in two rounds were 0.865 and 0.869,and Kendall coefficient in two rounds was 0.177 and 0.187,respectively.The differences were statistically significant(P <0.001).A pilot test of the decision support manual showed good availability.The finally formed assistant tool for treatment decision of patients with end-stage renal disease includes 4primary indicators,33 secondary indicators and the specific content.3.After one week of intervention,the scores of decision conflict and anxiety in the intervention group were significantly lower than those in the control group(P < 0.001 and P=0.005),the score of decision preparation in the intervention group was significantly higher than that in the control group(P < 0.001),and the proportion of uncertainty in dialysis treatment in the intervention group was significantly lower than that in the control group(15%vs 34%,P=0.026).Three months after dialysis,the intervention group overall physiological score in the quality of life score was significantly higher than that of the control group(P=0.004),and the decision-making regret score was significantly lower than that of the control group(P=0.002).Conclusions:1.The decision-making status of dialysis treatment for patients with end-stage renal disease is unsatisfactory.Professional decision-making aids should be developed and used to conduct pre-dialysis treatment decision-making education in advance,to rebuild patients cognition on dialysis treatment,to guide patients to actively participate in treatment decision-making,to pay attention to patients decision-making needs,and to improve their quality of life after dialysis.2.The treatment decision-making aids for patients with end-stage renal disease constructed in this study are scientific and reasonable,and achieve the unification of patient needs and the best clinical evidence,and have been recognized by patients and medical staff in the pilot test.Patients who choose renal replacement therapy wisely provide effective assistance.3.This randomized trial shows that the shared decision-making intervention method in which nurses use patient decision aids for decision-making coaching effectively reduces pre-dialysis patients decision-making conflicts and decision-making regrets,reduces anxiety levels,and improves patients decision-making readiness and physical health. |
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