Montoya Vicki, Conner Norma
College of Nursing, University of Central Florida, Orlando, FL, USA.
Am J Hosp Palliat Care. 2025 May;42(5):517-524. doi: 10.1177/10499091241276537. Epub 2024 Aug 22.
The largest patient group initiating dialysis for end-stage renal disease is persons over 75 years. Evidence indicates pre-dialysis shared decision-making discussions between nephrology providers and older adults are infrequent and often do not include an option for conservative management of symptoms without dialysis. : To assess and compare behavioral determinants of nephrology providers' use of comprehensive pre-dialysis shared decision-making discussions with older adults. A secondary aim was to prepare the bases for tailored behavioral intervention(s) for nephrology providers by identifying the determinant(s) that should be targeted to elicit change in comprehensive shared decision-making intentions and the resulting behavior. : A cross-sectional survey based on the Theory of Planned Behavior was completed by nephrologists from a state organization and nephrology advance practitioners from a national organization, either in person or online via Qualtrics. Survey respondents included nephrologists (n=29), and nurse practitioners (n=37) and physician assistants (n=7), combined, were predominantly female (83%) and White American (67%). Spearman rho correlation results showed attitude, social norm, and perceived behavioral control were correlated with shared decision-making behavior for one or both groups. Significant differences were present between the two groups for determinants and behaviors. Based on the determinants predominantly influencing SDM behavior of nephrology advance practitioners, behavioral interventions targeting the determinants of and are warranted. All determinants can be utilized in behavioral interventions for nephrologists.Opportunity exists for collaboration between providers to develop consistent and effective methods of SDM discussion that fit into a typical workday.
开始接受终末期肾病透析治疗的最大患者群体是75岁以上的人群。有证据表明，肾病科医护人员与老年人在透析前进行共同决策讨论的情况并不常见，而且往往不包括不进行透析而对症状进行保守管理的选项。：评估和比较肾病科医护人员与老年人进行全面透析前共同决策讨论的行为决定因素。第二个目的是通过确定应针对哪些决定因素来促使全面共同决策意图和最终行为发生改变，为针对肾病科医护人员的量身定制行为干预措施奠定基础。：来自一个州组织的肾病科医生以及来自一个全国性组织的肾病科高级从业者通过Qualtrics亲自或在线完成了一项基于计划行为理论的横断面调查。调查对象包括肾病科医生（n = 29），护士从业者（n = 37）和医师助理（n = 7），他们主要为女性（83%）和美国白人（67%）。斯皮尔曼等级相关结果显示，态度、社会规范和感知行为控制与一组或两组的共同决策行为相关。两组在决定因素和行为方面存在显著差异。基于主要影响肾病科高级从业者共同决策行为的决定因素，有必要针对[具体决定因素1]和[具体决定因素2]的决定因素进行行为干预。所有决定因素都可用于肾病科医生的行为干预。医护人员之间存在合作机会，以开发适合典型工作日的一致且有效的共同决策讨论方法。
