Shared Decision Making Increases Living Kidney Transplantation and Peritoneal Dialysis |
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| Affiliation: | 1. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan;2. Department of Pharmacy, Taichung Veterans General Hospital, Taiwan;3. School of Medicine, Chung Shan Medical University, Taichung, Taiwan;4. Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan;5. Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan;1. Transplant Center, Acibadem International Hospital, Istanbul, Turkey;2. Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey;1. Department of General Surgery, Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital, Istanbul, Turkey;2. Department of Nephrology, Ege University School of Medicine, Izmir, Turkey;3. Department of General Surgery, Ege University School of Medicine, Izmir, Turkey;4. Department of General Surgery, Manisa State Hospital, Manisa, Turkey;1. Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;2. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;3. Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;4. Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;5. Department of Organ Transplantation, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China;2. These authors contributed equally to this work and share first authorship;1. Department of Transplantation, Guy''s and St Thomas'' NHS Foundation Trust, Guy''s Hospital, London, UK;2. King''s Health Economics, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience at King''s College, London, UK;3. NHS Blood & Transplant, Bristol, UK;4. Clinical Transplantation Laboratory, Guy''s & St Thomas'' NHS Trust, Viapath, London, UK;5. MRC Centre for Transplantation, King''s College London, Guy''s Hospital, London, UK;1. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA;2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore Maryland, USA;3. Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA;1. University Health Network, Toronto, Ontario, Canada;2. University of Alabama at Birmingham, Birmingham, AL;3. Vanderbilt University, Nashville, TN;4. University of Virginia Health System, Charlottesville, VA;5. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;6. DaVita Home Modalities, Denver, CO;7. Quality Insights Renal Network 5, Mid-Atlantic Renal Coalition, North Chesterfield, VA;8. Wake Forest School of Medicine, Winston-Salem, NC |
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| Abstract: | BackgroundHospital accreditation in Taiwan encourages greater use of shared decision making (SDM) in health care. This study aimed to explore the distribution change of treatment modalities for renal replacement therapy (RRT) before and after the use of SDM in newly diagnosed end-stage renal disease (ESRD) patients.MethodsThe processes of SDM for RRT were designed with Internet-based patient educational program and smart system. The project of SDM was reviewed by departmental consensus meeting and continuously executed since January 2017. Patients received long-term RRT between January 2016 and December 2017 were enrolled.ResultsIn 2017, 310 patients (187 male, average 63.9 years old) received long-term RRT. Of them, 220 (71%) patients completed SDM for RRT. Sixty-six patients received peritoneal dialysis (PD), 67 patients entered the evaluation of living related kidney transplantation (KT) program, while 18 patients finally received operation for living KT. Compared to 2016, execution of SDM for RRT was associated with drastically increase of the number of living KT (38.5%) and PD (112.9%) after the implementation of SDM for RRT in 2017. The number of preemptive living KT was also increased from 1 patient to 5 patients. Moreover, 91.3% patients were satisfied with the process of SDM for RRT.ConclusionOur findings suggest that the implementation of SDM before patients entering long term RRT lead to more ESRD patients receiving living KT and entering PD therapy. The increasing trend of living KT could be reasonably expected if SDM for RRT could be carried out nationwide. |
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