Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
Department of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
BMC Med Inform Decis Mak. 2023 Aug 14;23(1):159. doi: 10.1186/s12911-023-02261-w.
Current healthcare trends emphasize the use of shared decision-making (SDM) for renal replacement treatment (RRT) in patients with chronic kidney disease (CKD). This is crucial to understand the relationship between SDM and illness perception of CKD patients. Few studies have focused on SDM and illness perception status of CKD patients and the impact of illness perception on RRT after SDM.
In this cross-sectional study, we used a questionnaire with purposive sampling from March 2019 to February 2020 at the nephrology outpatient department of a medical center in southern Taiwan. The nephrology medical team in this study used the SHARE five-step model of SDM to communicate with the patients about RRT and Brief Illness Perception Questionnaire (BIPQ) was applied to evaluate illness perception of these patients at the beginning of SDM. According to the SDM decision time, the study participants were classified general and delayed SDM groups. The distribution between SDM groups was estimated using independent two sample t-test, chi-squared test or Fisher's exact test. The correlation between illness perception and SDM decision time were illustrated and evaluated using Spearman's correlation test. A p-value less than 0.05 is statistically significant.
A total of 75 patients were enrolled in this study. The average time to make a dialysis decision after initiating SDM was 166.2 ± 178.1 days. 51 patients were classified as general group, and 24 patients were classified as delayed group. The median SDM decision time of delayed group were significantly longer than general group (56 vs. 361 days, P < 0.001). Our findings revealed that delayed group was significantly characterized with not created early surgical assess (delayed vs. general: 66.7% vs. 27.5%, p = 0.001) compared to general group. The average BIPQ score was 54.0 ± 8.1 in our study. We classified the patients into high and low illness perception group according to the median score of BIPQ. The total score of BIPQ in overall participants might increase by the SDM decision time (rho = 0.83, p = 0.830) and the linear regression line also showed consistent trends between BIPQ and SDM decision time in correspond cohorts. However, no statistically significant findings were found.
The patients with advanced chronic kidney disease took an average of five and a half months to make a RRT decision after undergoing SDM. Although there is no statistical significance, the trend of illness perception seems correlated with decision-making time. The stronger the illness perception, the longer the decision-making time. Furthermore, shorter decision times may be associated with earlier establishment of surgical access. We need more research exploring the relationship between illness perception and SDM for RRT in CKD patients.
目前的医疗保健趋势强调在慢性肾脏病（CKD）患者中使用共同决策（SDM）来选择肾脏替代治疗（RRT）。这对于了解 SDM 与 CKD 患者的疾病认知之间的关系至关重要。很少有研究关注 SDM 和 CKD 患者的疾病认知状况，以及疾病认知对 SDM 后 RRT 的影响。
本横断面研究于 2019 年 3 月至 2020 年 2 月在台湾南部一家医学中心的肾病门诊使用目的抽样法进行。本研究中的肾病医疗团队使用 SDM 的 SHARE 五步骤模型与患者就 RRT 进行沟通，并在 SDM 开始时使用简要疾病认知问卷（BIPQ）评估这些患者的疾病认知。根据 SDM 的决策时间，将研究参与者分为一般和延迟 SDM 组。使用独立样本 t 检验、卡方检验或 Fisher 精确检验估计 SDM 组之间的分布。使用 Spearman 相关检验说明和评估疾病认知与 SDM 决策时间之间的相关性。p 值小于 0.05 具有统计学意义。
本研究共纳入 75 例患者。启动 SDM 后进行透析决策的平均时间为 166.2±178.1 天。51 例患者被归类为一般组，24 例患者被归类为延迟组。延迟组的 SDM 决策时间中位数明显长于一般组（56 天与 361 天，P<0.001）。与一般组相比，延迟组的特点是明显未进行早期手术评估（延迟组与一般组：66.7%比 27.5%，p=0.001）。本研究中 BIPQ 的平均得分为 54.0±8.1。我们根据 BIPQ 的中位数将患者分为高和低疾病认知组。根据 BIPQ 的总分，所有参与者的疾病认知总分可能会随着 SDM 决策时间的增加而增加（rho=0.83，p=0.830），并且在相应队列中，BIPQ 和 SDM 决策时间之间的线性回归线也显示出一致的趋势。然而，没有发现统计学意义。
接受 SDM 的晚期慢性肾脏病患者平均需要五个半月的时间才能做出 RRT 决策。尽管没有统计学意义，但疾病认知的趋势似乎与决策时间相关。疾病认知越强，决策时间越长。此外，较短的决策时间可能与更早建立手术通道有关。我们需要更多的研究来探索 CKD 患者的疾病认知与 SDM 之间的关系，以选择 RRT。
