In Chronic kidney disease (CKD) management, the aim is to slow down kidney function decline. Numerous decisions (e.g. regarding long-term medication and lifestyle) are made during CKD outpatient visits, making patient involvement/activation essential. This thesis examines the application of SDM in CKD decisions and explores how outcome information can support SDM (and patient activation).
First, the scope of SDM was broadened through a literature review and empirical data from patient surveys and audio-observations of outpatient CKD visits. The findings show that SDM is not only relevant in major, preference-sensitive decisions, but also for routine decisions. However, the application of SDM in common CKD decisions was limited in the observational data.
Second, dyadic interviews between patients and clinicians revealed individual variation in which outcomes were considered important to discuss during consultations, as well as incorrect assumptions about each...
Show moreIn Chronic kidney disease (CKD) management, the aim is to slow down kidney function decline. Numerous decisions (e.g. regarding long-term medication and lifestyle) are made during CKD outpatient visits, making patient involvement/activation essential. This thesis examines the application of SDM in CKD decisions and explores how outcome information can support SDM (and patient activation).
First, the scope of SDM was broadened through a literature review and empirical data from patient surveys and audio-observations of outpatient CKD visits. The findings show that SDM is not only relevant in major, preference-sensitive decisions, but also for routine decisions. However, the application of SDM in common CKD decisions was limited in the observational data.
Second, dyadic interviews between patients and clinicians revealed individual variation in which outcomes were considered important to discuss during consultations, as well as incorrect assumptions about each other’s information needs. This highlights the importance of open, curiosity-driven dialogue.
Third, a CKD dashboard visualizing clinical and patient-reported outcomes during CKD consultations, was co-developed and evaluated. Although no significant changes in SDM levels and patient activation were observed, dashboard (correct) use broadened consultation topics and led to treatment adaptations.
Overall, this thesis underscores the value of SDM in routine CKD care and emphasize a tailored use of outcome information through by open dialogue.
Show less
