P MOUNT1,2,3, M BRANAGAN1, C ROYSTON1, IMPROVING PATIENT-PROVIDER COMMUNICATION EXPERT WORKING GROUP1
1Safer Care Victoria, Melbourne, Australia, 2Austin Health, Heidelberg, Australia, 3University of Melbourne, Parkville, Australia
Aim: This project aimed to improve patient-provider communication by involving patients in decisions about their care and reducing variation in the information provided at the time of consenting for renal dialysis.
Background: Patients with end stage kidney disease face complex treatment decisions about long term therapy including various forms of maintenance dialysis, kidney transplantation, or conservative care. A shared decision-making approach is recommended, which requires the patient to both receive adequate information, and to be sufficiently involved in the decision-making process. However, many patients on maintenance dialysis report not understanding all treatment options, including home dialysis, kidney transplantation and conservative care.
Methods: An expert working group consisting of consumers and clinicians was formed to review existing processes, and to identify and implement recommended standards for dialysis consent. A patient reported experience measure was developed to evaluate the effectiveness of the process.
Results: The working group identified 15 minimum recommended standards for inclusion in documents for written informed consent. These were summarised in a policy document, as well as supporting template consent forms for facility haemodialysis, home haemodialysis, and peritoneal dialysis. Following the project, 80% of Victorian public hospital dialysis services have commenced implementation of the policy. A pilot evaluation was performed in one health service (Austin Health) using the patient reported experience measure, finding that 90% of patients reported receiving the right amount of information about their care and treatment, and that 86% of patients reported feeling involved in decisions about their care as much as they wanted.
Conclusions: Standardised informed consent processes for maintenance dialysis reduced variation in the information received by patients and increased their involvement in decisions about their care.
A/Prof Peter Mount is the Clinical Lead for the Safer Care Victoria Renal Clinical Network, and Deputy Director of Nephrology at Austin Health.