Shared decision making: a personal view from two kidney doctors and a patient

Barnaby Hole; Miranda Scanlon; Charlie Tomson

doi:10.1093/ckj/sfad064

Shared decision making: a personal view from two kidney doctors and a patient

Barnaby Hole
, Miranda Scanlon
, Charlie Tomson^*

^*Corresponding author for this work

Bristol Medical School (PHS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

32 Citations (Scopus)

Abstract

Shared decision making (SDM) combines the clinician's expertise in the treatment of disease with the patient's expertise in their lived experience and what is important to them. All decisions made in the care of patients with kidney disease can potentially be explored through SDM. Adoption of SDM in routine kidney care faces numerous institutional and practical barriers. Patients with chronic disease who have become accustomed to paternalistic care may need support to engage in SDM—even though most patients actively want more involvement in decisions about their care. Nephrologists often underestimate the risks and overestimate the benefits of investigations and treatments and often default to recommending burdensome treatments rather than discussing prognosis openly. Guideline bodies continue to issue recommendations written for healthcare professionals without providing patient decision aids. To mitigate health inequalities, care needs to be taken to provide SDM to all patients, not just the highly health-literate patients least likely to need additional support in decision making. Kidney doctors spend much of their time in the consulting room, and it is unjustifiable that so little attention is paid to the teaching, audit and maintenance of consultation skills. Writing letters to the patient to summarise the consultation rather than sending them a copy of a letter between health professionals sets the tone for a consultation in which the patient is an active partner. Adoption of SDM will require nephrologists to relinquish long-established paternalistic models of care and restructure care around the values and preferences of patients.

Original language	English
Article number	sfad064
Pages (from-to)	i12–i19
Journal	Clinical Kidney Journal
Volume	16
Issue number	Supplement_1
DOIs	https://doi.org/10.1093/ckj/sfad064
Publication status	Published - 13 Sept 2023

Bibliographical note

Funding Information:
C.T.’s interest in SDM developed during a Health Foundation Quality Improvement Fellowship at the Institute for Healthcare Improvement (IHI) in 2003–2004. The IHI had adopted the mantra ‘no decision about me without me’ and were promoting shared decision making in their programs. While at the IHI, C.T. met Michael Barry [] to discuss clinical practice guidelines and began to understand some of the limitations of the model of clinical practice in which guidelines were directed at clinicians, with the implicit assumption that patients would do what their clinician advised. On returning to the UK he started to incorporate SDM into routine clinical practice as a general nephrologist, and also, as Chair of the UK Renal Registry, developed a national survey of the quality of decisions made by patients receiving care for advanced CKD in UK kidney units []. This work was funded by NHS Kidney Care thanks to the late Donal O'Donoghue [], who realised, before many others, the importance of patient involvement in kidney care. C.T. also gave advice on the content of web-based decision aids that were developed for use in the ‘Right Care’ program of the English NHS (no longer available) and has recorded video clips illustrating consultations with and without SDM [].

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Groups and Themes

Palliative and End of Life Care

Keywords

decision-making, decision support techniques, health inequities, kidney diseases, patient-centred care, shared

Access to Document

10.1093/ckj/sfad064Licence: CC BY-NC

Handle.net

Persistent link

Understanding the treatment preferences of older patients deciding between dialysis and conservative kidney management: the UNPACK Study
Hole, B. (Author), Caskey, F. (Supervisor), Selman, L. E. (Supervisor), Rooshenas, L. (Supervisor), Morton, R. L. (Supervisor) & Coast, J. (Supervisor), 24 Jan 2023
Student thesis: Doctoral Thesis › Doctor of Philosophy (PhD)

File

Cite this

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DO - 10.1093/ckj/sfad064

M3 - Article (Academic Journal)

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SN - 2048-8505

VL - 16

SP - i12–i19

JO - Clinical Kidney Journal

JF - Clinical Kidney Journal

IS - Supplement_1

M1 - sfad064

ER -

Shared decision making: a personal view from two kidney doctors and a patient

Abstract

Bibliographical note

UN SDGs

Research Groups and Themes

Keywords

Access to Document

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Student theses

Understanding the treatment preferences of older patients deciding between dialysis and conservative kidney management: the UNPACK Study

Cite this