Park Byung Hwa, Shin Ho Sik, Kim Jinseog, Lee Jeonghwan, Park Ji Hyeon, Ko Gang Jee, Hwang Won Min, Kim Do Hyoung, Lee Young Ki
Department of Internal Medicine, Renal Division, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea.
Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea.
Medicine (Baltimore). 2024 Nov 22;103(47):e40659. doi: 10.1097/MD.0000000000040659.
Chronic kidney disease (CKD) patients face critical decisions in choosing kidney replacement therapy such as hemodialysis (HD) or peritoneal dialysis (PD), which significantly affect their quality of life and health outcomes. Recent studies highlight the importance of shared decision-making (SDM) in helping patients understand their treatment options and make informed choices. SDM not only improves patient satisfaction and autonomy but also emphasizes the need for comprehensive pre-dialysis education to support optimal treatment selection.
Among patients with chronic kidney failure from 8 hospitals in Korea who started dialysis, 256 who participated in a pilot project for home management of PD were included in the present study. A mixed-methods study was conducted using questionnaires and semi-structured interviews. Our study focused on the effects of SDM on patient death, survival rate, HD conversion, emergency room visits, hospitalization days, and outpatient visits.
A significant difference was observed in hospitalization days (P = .0044) between the SDM and non-SDM groups. However, no significant differences were observed in survival rate, rate of conversion to HD, survival rate after conversion to HD, emergency room visit rate, number of hospitalizations per patient, outpatient visit rate, medical cost, hospitalization cost, outpatient cost, and phosphate-binding agent prescription rate.
This study emphasizes the benefits of SDM in reducing hospitalization days for PD patients, suggesting its potential role as a guide in future decisions regarding PD. PD provides a particularly beneficial home-based treatment alternative for patients facing challenges with hospital visits, supported by advanced technologies. Overseas, various countries are implementing policies and incentives to promote home dialysis, demonstrating the potential for SDM to enhance patient satisfaction and outcomes in dialysis care globally.
慢性肾脏病（CKD）患者在选择肾脏替代治疗方法时面临关键决策，如血液透析（HD）或腹膜透析（PD），这会显著影响他们的生活质量和健康结局。近期研究强调了共同决策（SDM）在帮助患者了解治疗选择并做出明智选择方面的重要性。共同决策不仅能提高患者满意度和自主性，还强调了进行全面透析前教育以支持最佳治疗选择的必要性。
在韩国8家医院开始透析的慢性肾衰竭患者中，本研究纳入了256名参与腹膜透析居家管理试点项目的患者。采用问卷调查和半结构化访谈进行混合方法研究。我们的研究聚焦于共同决策对患者死亡、生存率、转为血液透析、急诊就诊、住院天数和门诊就诊的影响。
共同决策组和非共同决策组之间在住院天数上观察到显著差异（P = 0.0044）。然而，在生存率、转为血液透析的比例、转为血液透析后的生存率、急诊就诊率、每位患者的住院次数、门诊就诊率、医疗费用、住院费用、门诊费用和磷结合剂处方率方面未观察到显著差异。
本研究强调了共同决策在减少腹膜透析患者住院天数方面的益处，表明其在未来腹膜透析决策中作为指导的潜在作用。腹膜透析为面临就诊困难的患者提供了一种特别有益的居家治疗选择，并有先进技术的支持。在海外，各国正在实施政策和激励措施以促进家庭透析，这表明共同决策在全球范围内提高透析护理患者满意度和结局方面具有潜力。
