AUTONOMOUS DECISION-MAKING IN ADULTS WITH CHRONIC KIDNEY DISEASE

CM MCKERCHER1, AJ VENN1, AL NEIL1, KA SANDERSON1,2, MD JOSE1,3,4

1Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; 2School of Health Sciences, University of East Anglia, Norwich, UK; 3School of Medicine, University of Tasmania, Hobart, Tasmania; 4Royal Hobart Hospital, Hobart, Tasmania

Aim: To examine preferences and factors associated with autonomous decision-making in adults with chronic kidney disease (CKD) prior to renal replacement therapy.

Background: Patients diagnosed with CKD are faced with incrementally complex decision-making through their treatment journey. The extent to which patients seek active involvement in the decision-making process has implications for quality of life and long-term health outcomes.

Methods: 122 adults (40 women, 33%) aged ≥18 years (71.5±11.3 years) with CKD (eGFR <30 mls/min/1.73m2) and not receiving dialysis were recruited via treating physicians. Patient preferences for information-seeking and decision-making were self-reported using the Autonomy Preference Index (API). Cross-sectional associations between demographic, psychosocial, and clinical factors with the information-seeking and decision-making scales of the API were examined using linear regression models adjusted for age, gender and occupational attainment where appropriate.

Results: Participants indicated a strong preference to be well-informed (Information-seeking scale, mean 0.81±0.11), but were more neutral in their preference to actively participate in decision-making (Decision-making scale, mean 0.43±0.17). Multivariate regression models indicated that an increased desire for information was associated with higher occupational attainment, higher executive functioning (Montreal Cognitive Assessment), higher self-reported symptoms/problems (Kidney Disease Quality of Life Short Form) and poorer self-reported physical health (SF-36 Physical Component Summary) (all p<0.05). An increased desire for involvement in decision-making was associated with younger age (p<0.01) and female gender (p<0.05) only.

Conclusions: While adults with CKD indicate a preference to receive medical information, this may not always imply a desire to be actively involved in the decision-making process. By taking into consideration factors that may affect patient preferences for autonomous decision-making, such as age and gender, health professionals may more successfully engage individual patients in decision-making.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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