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Clin Kidney J. 2016 Apr;9(2):252-9. doi: 10.1093/ckj/sfw003. Epub 2016 Mar 5.

Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK.

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The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; Department of Psychology, University of Hertfordshire, Hatfield, UK.
Leeds Institute of Health Sciences , University of Leeds , Leeds , UK.
UK Renal Registry , Bristol , UK.
King's College Hospital , Denmark Hill, London , UK.
Nottingham University Hospitals NHS Trust , Nottingham , UK.
Cochrane Institute of Primary Care and Public Health , Cardiff University , Cardiff , UK.
European Renal Best Practice (ERBP) Methods Support Team , University Hospital Ghent , Ghent , Belgium.
Scottish Renal Registry, Meridian Court , Glasgow , UK.
St James University Hospital , Leeds , UK.
Institute of Health and Society , Newcastle University , Newcastle upon Tyne , UK.
Department of Renal Medicine , Freeman Hospital , Newcastle upon Tyne , UK.



Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings.


We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90-180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry.


Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08-2.80) compared with 0.27 (range, 0.04-1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P < 0.0001). We found no difference in age, gender or social deprivation. In Phases 1 and 2, the majority reported a collaborative decision-making style (73 and 69%), and had no decisional conflict (85 and 76%); the median score for shared decision-making experience was 12.5 (Phase 1) and 10 (Phase 2) out of 20.


Our study shows the importance of assessing the feasibility of data collection in a chronic disease context prior to implementation in routine practice. Routine measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time.


chronic kidney disease; doctor–patient communication; implementation; routine measure; shared decision-making

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