Survey on patient satisfaction with a one-hour discussion on the choice of dialysis modality at the outpatient clinic.

Abstract

Dear Editor, It is widely known that shared decision-making (SDM) is a superior approach when choosing the dialysis modality in patients with end-stage kidney disease (ESKD). However, its impact on patient satisfaction has not been well investigated. We conducted this survey to clarify patient satisfaction with a 1-h discussion on the choice of dialysis modality at the outpatient clinic. This anonymous survey included ESKD patients who visited our outpatient clinic between February 10, 2020 and March 31, 2022. Details of the outpatient clinic have been described in a previous report [1]. Return of a completed questionnaire by the patient was considered as consent for study participation. Of the 74 patients who returned the questionnaire, 65 patients who fully completed it were included in the analysis. This survey was based on the Ministry of Health, Labor and Welfare's survey, evaluated on a 5-point scale (very satisfied, satisfied, neutral, somewhat dissatisfied, and very dissatisfied). Patient background items, such as age group, sex, underlying disease causing ESKD, history of nephrology visits, employment status, and cohabitation status. Subjective understanding of the clinical implications of hemodialysis (HD) and peritoneal dialysis (PD) before and after outpatient visits (rated on a 10-point scale) was also included. Forty-six patients were over 70 years old, 49 were male, and diabetic nephropathy was the cause of ESKD in 17 patients. Forty-eight patients had a history of nephrology consultations for more than 1 year, 19 were employed, and 58 lived with someone. Subjective comprehension of dialysis modality significantly increased after outpatient visits compared to before the visits (HD: 7.7 ± 1.8 vs. 4.9 ± 2.4 points, PD: 7.0 ± 2.3 vs. 3.7 ± 2.6 points, p < 0.01, respectively). Eighty-three percent of the patients responded that they were satisfied or very satisfied (Figure 1). Ordinal logistic regression analysis of factors associated with patient satisfaction revealed that patients with less than 1 year of nephrology outpatient visits had higher patient satisfaction than those with longer histories of consultations (odds ratio = 3.672 [95% confidence interval: 1.143, 11.792, p = 0.029]). A survey has been performed to assess treatment satisfaction for dialysis patients [2]. However, few studies have been performed to assess patient satisfaction with SDM for non-dialysis patients. The present study showed that patient satisfaction was not associated with improved subjective comprehension and was higher in patients with a short history of nephrology visits. It has been reported that patient satisfaction is associated with attendance at dialysis sessions [3]. Furthermore, surveying patient satisfaction provides feedback from ESKD patients and may lead to improved quality of care. However, the outcomes cannot be assessed due to this anonymous study. Late referral patients often do not have sufficient acceptance of ESKD, and we speculated that the high patient satisfaction was achieved by the medical staff taking the time to listen to the patient attentively. Recently, it has been reported that decision renal replacement therapy decision support improves decision quality in the elderly with ESKD [4]. Here, we highlight that high patient satisfaction with SDM results from communication rather than just provision of information on the dialysis modality.