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What is shared decision making?
Shared decision making is a collaborative process through which the clinician and patient arrive at a decision that is mutually agreeable to both of them and informed by the patient’s values and preferences.
A shared expertise is necessary to develop a patient-centered plan of care—the clinician as the expert in current evidence and best practice, with the patient as the expert in his or her own values and preferences.
What characteristics of patients with kidney disease underscore the importance for shared decision making in kidney disease population?
• Limited life expectancy: Survival among patients with ESKD is comparable to many common malignancies, and 1-year mortality for nursing home patients initiated on dialysis is more than 50%. Shared decision making is therefore an essential mechanism to deliver care that is consistent with patients’ values and preferences.
• Unmet symptom and end-of-life needs: Nephrology patients report substantial unmet needs in palliative care, and hospice use remains low for ESKD patients. Shared decision making encourages providers and patients to discuss and plan for future burdens and setbacks related to a given treatment path.
• Modality selection: For those initiating renal replacement therapy, modality selection is fundamentally based on the process of shared decision making.
