Table 4 Recommendations about how to improve decision making for this group of patients
Key finding | Recommendations to support decision making |
|---|---|
Participants demonstrated a high level of trust in healthcare professionals and the perception that professionals’ knowledge was superior to their own. | - Reinforce unique contribution of patients to decision-making (e.g. knowledge of personal contexts, values and preferences). - Acknowledge that there are no right or wrong answers in situations of equipoise [37]. |
Patient question-asking in healthcare settings appeared limited and reactive. | - Redefine perceptions of a good patient and reassure patients that participation and question-asking will not result in retribution [38]. - Enable patients to ask questions through the provision of question prompt lists [38]. |
Limited awareness/engagement in decisions other than RRT throughout CKD trajectory. | - Develop decision aids for decisions other than renal replacement therapy. - Reframe patient education materials to reinforce choice and patient engagement in formulating and adhering to treatment goals (e.g. diet and fluid restriction) [37]. |
Variability in: - Preferences for decision making - Amount of information provided to patients - Decision-making experiences | - Assess preferences for information and decision making. - Centralise resources across institutions, such as through an online repository. - Utilise health information technologies for the delivery of consistent information to patients regardless of institution/location. - Develop translated and culturally-adapted resources which are appropriate for the health literacy level of patients. - Provide training for health professionals (at all stages) to support shared decision-making [39]. - Provide training for patients to build skills and capacity to engage in decision-making [40]. |
Religion perceived as important to many people, but few thought it concerned healthcare decision-making. | - Clarify and agree on preferences regarding the discussion of religion upon commencement of consultation. |
Family played an important role in decision-making. | - Develop and disseminate decision support tools for family members. - Clarify and agree on preferences and roles for family members upon commencement of consultation [41]. |
Importance and value of GP | - Explore ways to facilitate shared decision-making within integrated care models, such as through training in inter-professionalism [42]. |