Nephrology Provider Engagement in Comprehensive Shared Decision-Making Discussions With Older Adults: Results of a Cross-Sectional Survey.

Abstract

Background: The largest patient group initiating dialysis for end-stage renal disease is persons over 75 years. Evidence indicates pre-dialysis shared decision-making discussions between nephrology providers and older adults are infrequent and often do not include an option for conservative management of symptoms without dialysis. Aims: To assess and compare behavioral determinants of nephrology providers' use of comprehensive pre-dialysis shared decision-making discussions with older adults. A secondary aim was to prepare the bases for tailored behavioral intervention(s) for nephrology providers by identifying the determinant(s) that should be targeted to elicit change in comprehensive shared decision-making intentions and the resulting behavior. Methods: A cross-sectional survey based on the Theory of Planned Behavior was completed by nephrologists from a state organization and nephrology advance practitioners from a national organization, either in person or online via Qualtrics. Results: Survey respondents included nephrologists (n=29), and nurse practitioners (n=37) and physician assistants (n=7), combined, were predominantly female (83%) and White American (67%). Spearman rho correlation results showed attitude, social norm, and perceived behavioral control were correlated with shared decision-making behavior for one or both groups. Significant differences were present between the two groups for determinants and behaviors. Conclusion: Based on the determinants predominantly influencing SDM behavior of nephrology advance practitioners, behavioral interventions targeting the determinants of Social Norm and Perceived Behavioral Control are warranted. All determinants can be utilized in behavioral interventions for nephrologists.Opportunity exists for collaboration between providers to develop consistent and effective methods of SDM discussion that fit into a typical workday.