Developing a Decision Support Intervention Regarding Choice of Dialysis Modality (Report‪)‬

Introduction Predialysis nurses have an important role in supporting patients with chronic kidney disease (CKD) stages 4 and 5 not on dialysis who face decisions about renal replacement therapy (RRT). Since the option of a kidney transplant is a limited option for many patients with CKD, choosing between hemodialysis and peritoneal dialysis is the more common, difficult decision (Harwood, Locking-Cusolito, Spittal, et al., 2005). In the absence of scientific evidence demonstrating the superiority of one option over the other, the decision about RRT lies in the preferences or values of the person with CKD stages 4 and 5 who is not on dialysis. This decision is often made following participation in an educational program in the predialysis clinic, coordinated by a nurse. In spite of this preparation, people experience decisional conflict, or personal uncertainty about the best course of action. In other care situations, decision support interventions have been effective in reducing decisional conflict and improving informed values-based decision-making. The Ottawa Decision Support Framework provides a structure to develop such interventions, which includes decision aids and decision coaching (O'Connor, Jacobsen, & Stacey 2002; O'Connor & Jacobsen, 2007). These interventions aim to improve the quality of decision-making. However, we were unable to find interventions developed for people with CKD stage 4 and 5 not on dialysis and their families. Our goal is to propose a method to develop and implement a decision support intervention for this patient population.